The inappropriate use of antimicrobials in clinical and agricultural settings has created suitable conditions for the evolution, emergence, and dissemination of AMR.
Overreliance on antimicrobials has resulted in an unprecedented selection pressure that spurred the proliferation of antimicrobial-resistant microorganisms in human, animal, and environmental microbiota.
These conditions also facilitate the mobilization and horizontal transfer of resistance determinants from commensal bacteria to those that can cause disease; especially with the accumulation of evolutionary events that select for resistance in host populations and environmental ecosystems.
Today, AMR is casting an ominous shadow; a critical health challenge with magnitudes dwarfing most life-threatening diseases such as HIV and malaria.
It has been famously predicted that 10 million people could die annually by 2050 if robust interventions to control AMR were not adopted. Recently, a comprehensive assessment showed that AMR directly caused an estimated 1.27 million deaths and was associated with 4.95 million deaths globally.
Taken together, AMR is a current and serious threat that might cause a global crisis, shifting the balance of the war against infectious diseases away from human and animal welfare. Unifying efforts to tackle the scourge of AMR are urgently required; including robust science-based monitoring of AMR transmission using the One Health ethos and investigating new advances in non-traditional and next-generation antimicrobial products that reduce reliance on conventional antimicrobials.
Although the highest toll of AMR burden is thought to affect developing countries, it is well-known that drug-resistant microorganisms can easily spill over across geographic borders to affect both developing and developed countries.
Unfortunately, limited data have been published on the epidemiology of AMR in LMICs, particularly among vulnerable populations (e.g., refugees) and in non-clinical settings (e.g., community, environment). Moreover, currently available data are usually incomplete and might not provide a comprehensive representation of the AMR burden, because the findings are based on small-scale studies and are temporally and spatially limited due to the lack of resources.
Therefore, it was very pertinent that argued that vulnerable populations, specifically refugees and their hosting communities in conflict zones, in the Middle East and beyond are at an elevated risk of life-threatening AMR infections. For example, Syrian refugees in makeshift camps and other disenfranchised populations in Lebanon are susceptible to infectious diseases and antimicrobial-resistant pathogens, which are amplified by COVID-19 and dire social and economic situations. In Lebanon, MDR Gram-negative bacterial infections have been reported in critical patients diagnosed with COVID-19 in clinical settings. Interestingly, the mobile colistin resistance gene (mcr-1.26), previously isolated in a pigeon in Lebanon, was reported in a Lebanese hospital.
Given the rapid spread of resistance, it is imperative to seek novel antimicrobial agents and other therapeutic options to overcome increasing rates of AMR and treat life-threatening MDR infections. Eravacycline, a relatively new fluorocycline antimicrobial with broad-spectrum efficacy against common clinical pathogens, was not inferior to ertapenem and meropenem in adult patients with complicated intra-abdominal infections.
Subsequently, Eravacycline might represent an excellent option for the treatment of these infections. Although there is a pressing demand for new antimicrobials, the use of antimicrobial alternatives (i.e., non-antibiotic antimicrobial therapies) is also sorely needed, especially when noting the decline in
A Guest Editorial