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Neonatal Legionella pneumophila infection is rare and mortality is high. There has been limited success with the use of extracorporeal membrane oxygenation, with reported mortality in infants of 88%. We present the case of a 5 day old infant with neonatal legionellosis who had been exposed to cold mist humidifiers in the home, filled from a domestic water supply contaminated with legionella. The infant was treated with veno-arterial extracorporeal membrane oxygenation and survived with subsequently normal neurodevelopmental follow-up. In view of the rapid growth of the worldwide humidifier market, the association between neonatal legionella and use of cold mist humidification may be important. Consideration of legionellosis should be given for any neonate presenting with severe sepsis or respiratory compromise who has been exposed to aerosol generating home humidifiers. In spite of previously reported high mortality in infants, this case demonstrates that excellent outcome is possible with early escalation to VA ECMO.

Antimicrobial resistance (AMR) in populations experiencing war has yet to be addressed, despite the abundance of contemporary conflicts and the protracted nature of twenty-first century wars, in combination with growing global concern over conflict-associated bacterial pathogens. The example of the Syrian conflict is used to explore the feasibility of using existing global policies on AMR in conditions of extreme conflict. The available literature on AMR and prescribing behaviour in Syria before and since the onset of the conflict in March 2011 was identified. Overall, there is a paucity of rigorous data before and since the onset of conflict in Syria to contextualize the burden of AMR. However, post onset of the conflict, an increasing number of studies conducted in neighbouring countries and Europe have reported AMR in Syrian refugees. High rates of multidrug resistance, particularly Gram-negative organisms, have been noted amongst Syrian refugees when compared with local populations. Conflict impedes many of the safeguards against AMR, creates new drivers, and exacerbates existing ones. Given the apparently high rates of AMR in Syria, in neighbouring countries hosting refugees, and in European countries providing asylum, this requires the World Health Organization and other global health institutions to address the causes, costs, and future considerations of conflict-related AMR as an issue of global governance. Keywords: Syria, Antimicrobial resistance, Conflict, Refugees