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This study compared antimicrobial resistance (AMR) rates and surveillance efforts in conflict-affected, fragile, and non-conflict countries, further subdivided by income.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Data on bacteriologically confirmed bloodstream infections (BC-BSIs) from 2017 to 2021 were extracted from the WHO GLASS database. Countries were classified as conflict-affected, fragile, or non-conflict (subdivided by income) using World Bank criteria. Descriptive statistics (mean\u2009\u00b1\u2009SD) were calculated, and group comparisons were performed using unpaired t-tests with Welch\u2019s correction. Mean differences (MD) and 95% confidence intervals (<jats:italic>CI<\/jats:italic>) were reported.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Conflict-affected countries reported significantly fewer surveillance sites than non-conflict countries (MD: 0.60, 95% <jats:italic>CI:<\/jats:italic> 0.361 to 0.836, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and fewer BC-BSIs per million population (MD: 31.00, 95% <jats:italic>CI:<\/jats:italic> 17.210 to 44.790, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). In conflict zones, <jats:italic>Acinetobacter<\/jats:italic> spp. and <jats:italic>S. aureus<\/jats:italic> represented a higher proportion of BSIs compared to non-conflict countries (<jats:italic>Acinetobacter<\/jats:italic> spp. MD: -11.86, 95% <jats:italic>CI:<\/jats:italic> \u2212\u00a027.130 to 3.399, <jats:italic>P<\/jats:italic>\u2009=\u20090.099; <jats:italic>S. aureus<\/jats:italic> MD: \u2212\u00a010.68, 95% <jats:italic>CI:<\/jats:italic> \u2212\u00a030.030 to 8.680, <jats:italic>P<\/jats:italic>\u2009=\u20090.203). Carbapenem resistance in <jats:italic>Acinetobacter<\/jats:italic> spp. exceeded 65% across the groups, peaking in fragile zones (83.38%). Third-generation cephalosporin-resistant <jats:italic>E. coli<\/jats:italic> (3GCREC) prevalence ranged from 47.99% to 76.34%, peaking in conflict zones (76.34%). Carbapenem-resistant <jats:italic>E. coli<\/jats:italic> (CREC) prevalence ranged from 2.31% to 15.95%, highest in non-conflict low-middle income countries (15.95%). Third-generation cephalosporin-resistant <jats:italic>K. pneumoniae<\/jats:italic> (3GCRKP) exceeded 50% in all groups, peaking in conflict zones (80.42%). The prevalence of carbapenem-resistant <jats:italic>K. pneumoniae<\/jats:italic> (CRKP) ranged from 14.49% to 45.70%, peaking in conflict zones and non-conflict low-middle income countries (45.70%). Methicillin-resistant <jats:italic>S. aureus<\/jats:italic> (MRSA) exceeded 30%, peaking in conflict zones (70.09%).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Conflict-affected countries have weaker AMR surveillance and lower BC-BSI detection but a higher burden of resistant pathogens, notably carbapenem-resistant <jats:italic>Acinetobacter<\/jats:italic> spp. and MRSA. Tailored strategies are essential to restore infrastructure, strengthen surveillance, and mitigate the long-term impact of AMR in these zones.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1186\/s40249-025-01287-8","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T07:15:14Z","timestamp":1740726914000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Antimicrobial resistance surveillance and trends in armed conflict, fragile, and non-conflict countries of the Eastern Mediterranean Region"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3818-7555","authenticated-orcid":false,"given":"Rima","family":"Moghnieh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazih","family":"Bizri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dania","family":"Abdallah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed H.","family":"Sayegh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,28]]},"reference":[{"key":"1287_CR1","doi-asserted-by":"crossref","unstructured":"Antimicrobial resistance: a silent pandemic. 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