Heavy metal toxicity in armed conflicts potentiates AMR in A. baumannii by selecting for antibiotic and heavy metal co-resistance mechanisms

Wael Bazzi, Antoine G. Abou Fayad, Aya Nasser, Louis-Patrick Haraoui, Omar Dewachi, Ghassan Abou-Sitta, Vinh-Kim Nguyen, Aula Abara, Nabil Karah, Hannah Landecker, Charles Knapp, Megan M. McEvoy, Mohammad H. Zamman, Paul G. Higgins, Ghassan M. Matar

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Acinetobacter baumannii has become increasingly resistant to leading antimicrobial agents since the 1970s. Increased resistance appears linked to armed conflicts, notably since widespread media stories amplified clinical reports in the wake of the American invasion of Iraq in 2003. Antimicrobial resistance is usually assumed to arise through selection pressure exerted by antimicrobial treatment, particularly where treatment is inadequate, as in the case of low dosing, substandard antimicrobial agents, or shortened treatment course. Recently attention has focused on an emerging pathogen, multi-drug resistant A. baumannii (MDRAb). MDRAb gained media attention after being identified in American soldiers returning from Iraq and treated in US military facilities, where it was termed “Iraqibacter.” However, MDRAb is strongly associated in the literature with war injuries that are heavily contaminated by both environmental debris and shrapnel from weapons. Both may harbor substantial amounts of toxic heavy metals. Interestingly, heavy metals are known to also select for antimicrobial resistance. In this review we highlight the potential causes of antimicrobial resistance by heavy metals, with a focus on its emergence in A. baumanni in war zones.
Original languageEnglish
Article number68
Number of pages12
JournalFrontiers in Microbiology
Publication statusPublished - 3 Feb 2020
EventWar: the beginning and end of antibiotics? - Brocher Fondation, Geneva, Switzerland
Duration: 1 Nov 20183 Nov 2018


  • Acinetobacter baumannii
  • antimicrobial agents
  • heavy metals
  • antimicrobial resistance

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