Antimicrobial resistance (AMR) has become a pressing global health concern, and its impact is magnified in the setting of armed conflict. Wars undermine health systems by disrupting infection prevention and control, damaging water and sanitation infrastructure, limiting access to diagnostics, and driving unregulated use of antimicrobials. Infections of war wounds typically follow a temporal pattern: gram-positive organisms dominate the early phase, whereas gram-negative pathogens increasingly complicate care in the following days. Reports consistently describe high rates of methicillin-resistant Staphylococcus aureus (MRSA), while among gram-negative bacteria, Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae are the principal multidrug-resistant agents. In the Eastern Mediterranean Region, resistance levels are among the highest recorded worldwide, with carbapenem-resistant A. baumannii and extended-spectrum β-lactamase (ESBL)–producing Enterobacterales being especially common. In Ukraine, recent analyses highlight the predominance of metallo-β-lactamases, particularly NDM in Enterobacterales and P. aeruginosa, and OXA-23/-72 in A. baumannii. Forced displacement on an unprecedented scale further accelerates the cross-border spread of resistant strains. Surveillance, however, remains patchy: laboratory capacity is frequently impaired, and available studies are heterogeneous in methods and quality, limiting accurate assessment of the burden. This review brings together evidence from recent conflicts in the Middle East and Ukraine, examining resistance trends, underlying drivers, and their implications for clinical practice. Addressing AMR in conflict requires immediate, pragmatic steps: restoration of infection control and water systems, targeted screening of high-risk patients, context-specific antimicrobial stewardship, and the development of lean but standardized surveillance systems suited to resource-limited and insecure environments.

In clinical practice, healthcare providers encounter a rising incidence of aspergillosis, which significantly affects morbidity and mortality in vulnerable patients. Over the past few decades, molds have increasingly affected patients with underlying pleuropulmonary, hematological, or oncological diseases undergoing cytotoxic treatment or immunosuppression, leading to impaired cell-mediated immunity and an increased risk of postoperative complications. Although the spectrum of Aspergillus infection is variable, ranging from allergic to chronic, invasive manifestation, pleural involvement is rarely reported. Pleural aspergillosis is an extrapulmonary manifestation of invasive aspergillosis, associated with thoracic surgical procedures and with a bronchopleural fistula, not necessarily combined with pulmonary aspergillosis. An elective or emergency thoracic surgery in immunocompromised patients increases the risk of postoperative infectious complications. Herein, we report a case of isolated postoperative pleural aspergillosis in a 28-year-old immunocompromised man with metastatic synovial sarcoma in the lungs, who underwent pleurodesis for pneumothorax, lobectomy for lung metastasis, and subsequently required decortication and thoracoplasty to achieve effective control of infection. To address this, the patient responded well to aggressive surgical debridement along with both systemic and intrapleural antifungal agent instillation. The essential in vitro diagnostics, including microscopy, microbiological culture and histopathological examination, both from necrotic pleural specimens, detected Aspergillus fumigatus, a global priority species of invasive aspergillosis. Postoperative aspergillosis with pleural involvement and bronchopleural fistula, in immunocompromised patients with sarcoma, is rarely reported, requiring a combination of surgical approach and optimized antifungal treatment regimens. The current knowledge on pleural aspergillosis management remains limited, and highlights the need for case reporting to refine expertise.