Personalized and Precision Medicine Journal

Abstract Background:
Multidrug-resistant (MDR) bacteria, including Acinetobacter baumannii, have increased in healthcare systems, particularly in the Middle East. This bacterium is notoriously resistant to various medications, complicating disease therapy. The proliferation of XDR bacteria and the decline of effective antibiotics threaten patient safety and healthcare efficiency.
Objectives:
This study addresses the issues associated with MDR Acinetobacter baumannii in hospitals, especially in the Middle East. It examines the bacterium's epidemiology, molecular resistance mechanisms, clinical problems, and innovative treatment approaches. The research employs novel epidemiological data, molecular insights, and enhanced infection control strategies to comprehend the evolution of this issue and its management.
Methods:
We conducted a comprehensive study by searching PubMed, Scopus, and Web of Science for research published from 2010 to 2024. The investigation identified Middle Eastern research regarding the prevalence, resistance mechanisms, clinical care, and patient outcomes of MDR Acinetobacter baumannii. This study offers a comprehensive perspective on the escalating threat posed by this disease and its ramifications for regional healthcare professionals through the integration of qualitative and quantitative data.
Results:
Carbapenem-resistant Acinetobacter baumannii is common in 60–70% of Middle Eastern intensive care units and kills 40–50%. OXA-type carbapenemases, ESBLs, MBLs, efflux pump overexpression, target site changes, and biofilm formation make the bacterium resistant. We also found novel resistance determinants including bla_OXA-235 and regulatory gene alterations like adeRS. Overcrowded hospitals, long stays, antibiotic overuse, and poor infection control aggravate this issue. However, these issues are being fixed. Modern molecular diagnosis, ultraviolet disinfection, and genetic surveillance reduce these diseases.
Conclusions:
Increasing MDR Acinetobacter baumannii prevalence in the Middle East presents a difficult challenge that requires a coordinated, multidisciplinary approach. This pathogen's hazards can be reduced by improved antimicrobial stewardship, infection control, regional surveillance, and therapeutic development.

Abstract Drug resistance is a major obstacle in the effective treatment of cancer, severely impacting patient outcomes and complicating therapeutic strategies. The development of resistance is multifactorial, involving a combination of genetic and epigenetic changes within cancer cells, alterations in drug metabolism, increased DNA repair mechanisms, overexpression of drug efflux pumps, and complex interactions with the tumor microenvironment. These factors work synergistically to render traditional chemotherapy and targeted therapies less effective over time.
Recent advances in molecular biology, particularly next-generation sequencing and the CRISPR-Cas9 gene-editing tool, have significantly enhanced our understanding of the underlying mechanisms driving resistance. These technologies have enabled researchers to identify novel genetic mutations and signaling pathways that cancer cells exploit to evade treatment, offering new potential targets for therapeutic intervention. Additionally, the dynamic role of the tumor microenvironment, including immune cells, stromal cells, and extracellular matrix components, has emerged as a key factor influencing drug resistance, further complicating treatment strategies.
To address these challenges, several innovative therapeutic approaches are being explored. Combination therapies, which involve the use of multiple drugs targeting different pathways simultaneously, hold promise in overcoming resistance by attacking cancer cells from multiple fronts. Immunotherapy, which harnesses the body's immune system to target cancer cells, is also showing significant potential in resistant cancers. Furthermore, nanomedicine, which uses nanoparticles to deliver drugs directly to tumors, may improve drug efficacy and minimize resistance.
Despite these advancements, much remains to be done. Ongoing research focused on identifying reliable biomarkers, developing personalized medicine approaches, and understanding the intricate relationship between cancer cells and their microenvironment is essential. This review aims to provide a comprehensive overview of the current state of knowledge regarding drug resistance in cancer, emerging therapeutic strategies, and future research directions in this critical field.