{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:27:30Z","timestamp":1777922850432,"version":"3.51.4"},"reference-count":53,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T00:00:00Z","timestamp":1527811200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:p>\n                    The ongoing Libyan conflict constantly causes victims among the military and civilian population. Cross-border transfer of patients represents a high risk of introducing multidrug-resistant organisms (MDROs), for example, methicillin-resistant\n                    <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                    (MRSA), vancomycin-resistant enterococci, and carbapenem-resistant gram-negative organisms (CROs), into the country of destination. This study assessed the MDRO status in Libyan war casualties (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200967) admitted to Northwest Medical Centre in Frankfurt\/Main, Germany, from August 2016 till January 2017. Identified multidrug-resistant nonfermenters and Enterobacteriaceae were subjected to molecular detection of \u03b2-lactamases and further mechanisms of resistance. All isolates were typed by enzymatic macrorestriction and subsequent pulsed-field gel electrophoresis. MDROs were found in 40 (60%) patients, including 25 (37%) positive for at least one CRO and 11 (16%) patients with MRSA. A total of 37 isolates of\n                    <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">Acinetobacter baumannii<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">Enterobacter cloacae<\/jats:italic>\n                    , and\n                    <jats:italic toggle=\"yes\">Serratia marcescens<\/jats:italic>\n                    produced carbapenemases: NDM (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200917), OXA-48 (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200915), and OXA-23 (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u20099) in addition to other \u03b2-lactamases (with\n                    <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                    <jats:sub>CTX-M-group-1<\/jats:sub>\n                    being most frequent) and plasmid-mediated quinolone resistance genes (\n                    <jats:italic toggle=\"yes\">qnrB, aac(6\u2032)Ib-cr<\/jats:italic>\n                    ). Bacterial strain typing revealed the presence of various clones. This high MDRO rate in Libyan war casualties demands awareness, appropriate screening, and containment measures for medical institutions involved in medical care to avoid patient-to-patient transmission.\n                  <\/jats:p>","DOI":"10.1089\/mdr.2017.0141","type":"journal-article","created":{"date-parts":[[2017,10,17]],"date-time":"2017-10-17T11:55:30Z","timestamp":1508241330000},"page":"578-584","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":22,"title":["High Prevalence of Multidrug-Resistant Bacteria in Libyan War Casualties Admitted to a Tertiary Care Hospital, Germany"],"prefix":"10.1177","volume":"24","author":[{"given":"Benedikt","family":"Lohr","sequence":"first","affiliation":[{"name":"Institute for Laboratory Medicine","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvonne","family":"Pfeifer","sequence":"additional","affiliation":[{"name":"Robert Koch-Institute","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ursel","family":"Heudorf","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Hygiene, Public Health Department, Frankfurt\/Main, Germany."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Rangger","sequence":"additional","affiliation":[{"name":"Northwest Medical Centre","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas E.","family":"Norris","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus-Peter","family":"Hunfeld","sequence":"additional","affiliation":[{"name":"Institute for Laboratory Medicine","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,6]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Amnesty International. 2016. Libya Annual report 2015\/2016. Available at https:\/\/www.amnesty.org\/en\/countries\/middle-east-and-north-africa\/libya\/report-libya. (last accessed February 1 2017)."},{"key":"e_1_3_3_3_2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.ijantimicag.2012.05.003","article-title":"Patients transferred from Libya to Denmark carried OXA-48-producing Klebsiella pneumoniae, NDM-1-producing Acinetobacter baumannii and meticillin-resistant Staphylococcus aureus","volume":"40","author":"Hammerum A.M.","year":"2012","unstructured":"Hammerum A.M., , Larsen A.R., , Hansen F., , Justesen U.S., , Friis-M\u00f8ller A., , Lemming L.E., , Fuursted K., , Littauer P., , Sch\u00f8nning K., , Gahrn-Hansen B., , Ellermann-Eriksen S., , and Kristensen B.. 2012. Patients transferred from Libya to Denmark carried OXA-48-producing Klebsiella pneumoniae, NDM-1-producing Acinetobacter baumannii and meticillin-resistant Staphylococcus aureus. Int. J. Antimicrob. Agents, 40:191\u2013192.","journal-title":"Int. J. Antimicrob. Agents"},{"key":"e_1_3_3_4_2","doi-asserted-by":"crossref","first-page":"E285","DOI":"10.1111\/1469-0691.12135","article-title":"Colonization of Libyan civil war casualties with multidrug-resistant bacteria","volume":"19","author":"Koole K.","year":"2013","unstructured":"Koole K., , Ellerbroek P.M., , Lagendijk R., , Leenen L.P.H., , and Ekkelenkamp M.B.. 2013. Colonization of Libyan civil war casualties with multidrug-resistant bacteria. Clin. Microbiol. Infect., 19:E285\u2013E287.","journal-title":"Clin. Microbiol. Infect."},{"key":"e_1_3_3_5_2","unstructured":"European Centre for Disease Prevention and Control (ECDC). 2015. Antimicrobial resistance surveillance in Europe: annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). 2015. 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