Genomic characterization of Gram-negative bacteria isolated from conflict-trauma patients in a southern Lebanese hospital
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION Conflict-related injuries create a unique environment for the emergence of antimicrobial-resistant pathogens.METHODS To clarify the burden and dynamics of resistance in this high-risk population, we investigated the genomic and clinical profiles of 63 Gram-negative bacterial isolates recovered exclusively from conflict-trauma cases in Southern Lebanon during the 2024 war.RESULTS Whole-genome sequencing revealed Acinetobacter baumannii (31.7%) and Escherichia coli (20.6%) as the predominant species, marking a significant epidemiological shift toward A. baumannii compared to pre-conflict baselines. Acquired antimicrobial resistance genes were detected in 66.7% of isolates, with a high prevalence of determinants and mutations targeting aminoglycosides (87%), fluoroquinolones (74.6%), and carbapenems (54%). Carbapenem resistance was primarily driven by acquired blaOXA carbapenemases and blaNDM variants; notably, we report the first detection of blaNDM-40 in Lebanon, alongside blaNDM-1 and blaNDM-5. Clinically, the admitted cases (n = 23) experienced intensive broad-spectrum antibiotic exposure, high rates of major surgery (74%), and documented hospital-acquired infections (48%), culminating in a 17.4% mortality rate among admitted cases. Minimum spanning tree analysis highlighted clonal, healthcare-associated transmission for A. baumannii and Klebsiella pneumoniae, contrasted by polyclonal distributions for E. coli and Pseudomonas aeruginosa.CONCLUSION Extensive broad-spectrum antibiotic exposure and acute trauma care within compromised healthcare infrastructures accelerate the selection of multidrug-resistant (MDR) genotypes. Mitigating this dissemination in conflict settings requires integrating genomic surveillance with targeted antimicrobial stewardship and infection control.
Institutions: Beirut Arab University, American University of Beirut, Université de Sherbrooke, World Health Organization, Hammoud Hospital University Medical Center, Alexandria University, University of Cologne, German Center for Infection Research, Canadian Institute for Advanced Research, Centre intégré de santé et de services sociaux de la Montérégie-Centre
Language: English
Subfield: Molecular Medicine
Domain: Life Sciences
Open Access status: hybrid
OpenAlex ID: W7172315468