Since September 22, 1980, when then-Iraqi President Saddam Hussein launched his offensive against neighboring Iran, Iraq has experienced the Iran-Iraqi War (1980-1988), the invasion of Kuwait (1990), the two wars against United States (1990-1991 and 2003-2011) and the violence unleashed by the Islamic State (IS) since 2014. Neither Hussein, who died by hanging, nor the United States, which left the country worse than it found it. , nor the Islamists, won their respective wars.
Only bacteria have won in each of them, with the emergence of resistance to most antibiotics.
A danger that does not stay behind its borders.
Bacterial resistance to antibiotics already kills more than AIDS and malaria, and by 2050 some 12 million people a year will die from superbugs.
Although genetic analysis has shown that some bacteria had developed defenses before Alexander Fleming encountered penicillin, the main cause of resistance has been the abuse and misuse of these drugs.
But there is another open front and the battle is being lost there too: the wars and, leaving Palestine aside, there is no country that has had more of that (40 years) in its recent history than Iraq.
A group of researchers led by Antoine Abou Fayad, a microbiologist at the American University of Beirut (Lebanon), has reviewed the evolution of bacterial resistance in Iraq.
There is not much data from the eight years of the war with Iran, but in his work, just published in the medical journal
BMJ Global Health
they mention several studies with Iranian soldiers wounded on the front lines, whose wounds had been colonized by resistant bacteria. .
The most common was
, one of the most deadly if it coincides with another pathology.
The World Health Organization (WHO) has it on its list of the most dangerous microbes for which it is urgent to find new antibiotics, having developed resistance to methicillin and vancomycin.
“Bacterial resistance to antibiotics is always more aggressive and chaotic during conflicts”
Antoine Abou Fayad, microbiologist at the American University of Beirut, Lebanon
“Bacterial resistance to antibiotics is always more aggressive and chaotic during conflicts,” says Abou Fayad.
“Different factors intervene: lack of microbiologists, nursing staff and doctors, absence of various kinds of antibiotics, internally displaced people and, in addition, there is contamination by heavy metals.
These can trigger antibiotic resistance in bacteria, as heavy metals can also kill them in a similar way,” he adds.
And these metals abound in warfare: Chromium, copper, lead, nickel, and zinc are used to coat bullets, missiles, cannons, or military vehicles.
Meanwhile, lead, mercury, antimony, barium or boron are part of the explosive charge.
these elements persist in the environment and can also be released from destroyed buildings.
Since the Vietnam War it is known that many bacterial species have developed resistance to combat the toxicity of heavy metals.
For the authors of the study, the combination of all these factors with the number and diversity of injuries, the movements of the displaced and refugees, as well as the conditions of the field hospitals, causes a selective pressure that favors the appearance of superbugs.
It was with the repatriation of the first US soldiers wounded during the 2003-2011 Iraq war (and also from Afghanistan, which began in 2001) that the Western media and science took notice of the problem.
Soldiers arrived at hospitals in the United States with wounds that were difficult to close, and that country's military health took precautions: debridement, cleaning of wounds that was done on the ground, was very demanding and was cut as far as necessary. to avoid infection.
In addition, treatment with antibiotics was only done after culture, to choose the most appropriate treatment.
But they could not avoid taking the four horsemen of the bacterial apocalypse from Iraq: the aforementioned
, but also
, naturally resistant to a wide variety of antibiotics,
, one of the unwanted visitors to ICUs and the most feared, the
This superbug, which the WHO has placed at the top of its list for its widespread resistance, has been dubbed the
iraqibacter by the US media.
Hundreds of soldiers, of the 30,000 who were wounded in both conflicts, had some of these bacteria when they were treated in US hospitals.
Several of them had to be amputated, not as a direct consequence of the wounds, but due to bacterial infections, in particular by
or a combination of both
If that happened in the first power in the world, what would be the situation in Iraq, among the civilians and the military of all the Iraqi sides?
The authors regret that there are no global data.
But there are many partial studies, from specific hospitals.
For example, a study carried out in Baghdad with almost 500 injured by attacks and clashes with the Islamists of the Islamic State in the first half of 2015 identified several
A. baumannii strains.
in 96 of them.
In 87.5% of the cases, they were bacteria with resistance to a dozen families of antibiotics.
Further north, in Mosul, a study carried out by Doctors Without Borders in a hospital they set up in 2018 showed that, in the first months of operation, 40% of those admitted had a bacterial infection.
In an MSF note, its antibiotic resistance adviser, Ernestina Repetto, stated at the time: "Of the bacteria that could be isolated, the vast majority already demonstrated a multi-resistance pattern, which automatically reduces treatment options."
Medical science knows that the first thing to do with a patient carrying a superbug is to isolate him.
But although it was the obligatory practice in the military hospitals of the United States, that did not prevent the nosocomial infection (those that a patient takes from the hospital center and that he did not have when entering).
There is no data on what could have happened in Iraqi hospitals.
Abou Fayad recalls that the problem has not remained within the borders of Iraq.
"The discovery of the gene for the NDM-1 enzyme was in an Iraqi war-wounded patient who went to India seeking medical help," he warns.
The NDM-1 gene for the enzyme beta-metallo-lactamase, discovered in 2009 in a strain of
, makes the bacteria that generate it resistant to almost all antibiotics, including last-resort antibiotics such as carbapenems .
The worst thing is that this gene is jumping to other strains and species of bacteria by horizontal gene transfer.
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