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Making medical countermeasures requires documentation to assess vulnerabilities, threats and operational risks and bioterrorism through the collection and processing of specific multidisciplinary data in human medicine, veterinary, phytosanitary, the environment, defense and national security, etc. Based on retrospective data and late information (medical intelligence), we can estimate the prospective risk to public health, respectively for troops and civilian population in a given area, the area of operations. The biological military or bioterrorist attack, whether overtly or masqueraded as human or animal epidemics can cause a major biological crisis for troops and the civilian population, for domestic and wild animals, for crops or wild plants or for the environment, which remains contaminated. Therefore, it is important to constantly monitor the situation of infectious diseases in the area of responsibility (national territory, operations theaters) to assess vulnerability, threat and bioterrorist risk but also for making medical anti-bioterrorist countermeasures, which can only be effective by genuine cooperation between all specialized structures of the Ministry of Defense, other departments and the civil society.

Knowledge of antibiotic resistance mechanisms is absolutely necessary to successfully fight against multi-resistant bacteria, the solutions to this issue being a direct consequence of understanding the mechanisms underlying its occurrence. Considering that in Romania more than 92.3% of patients have been receiving antimicrobial prophylaxis in surgery for more than one day, and empirical therapy is very common, the increasing antibiotic resistance is an important problem. The experiments were performed at the Military Medical Research Center on the 26 multiple drug resistance (MDR) bacterial strains from health care-associated infections (HAI): Escherichia coli (3), Klebsiella spp. (4), Pseudomonas aeruginosa 10), Proteus mirabilis (1), Staphylococcus aureus (7) and Enterobacter cloacae (1). They were isolated and initially identified by the Medical Analysis Laboratory of the Dr. Al. Gafencu Emergency Military Hospital, Constanta and the Microbiology Laboratory from the Military Medical National Institute for Research and Development Cantacuzino of Bucharest. Bacterial strains were reseeded on specific culture media, and identification was based on culture, morpho-tinctorial characters and biochemical properties. Antibiotic susceptibility testing was performed by the Kirby-Bauer diffusion method, following the CLSI 2016 guidelines. The results obtained lead to the idea of reconsidering the strategy for the use of antimicrobial substances by the following actions: performing in vitro sensitivity tests, close collaboration between the clinician and microbiologist, finding additional methods for assessing the effective concentrations of the antibiotic at the level of the infections. The observed percentage of antibiotic resistance in our study was 85.72%, that being much higher than the mentioned percentage by the European Antibiotic Surveillance Report (EARS-Net) for Romania in 2013 (25-50%).

The biological agent most likely to be used as a biological weapon is Bacillus anthracis, which causes the anthrax infectious disease. During the Cold War, it was present in large quantities in the military arsenals of some states, and at the beginning of the 21st century was used in a series of small bioterrorist attacks. In case of occurrence of events using Bacillus anthracis, urgent and adequate qualitative and quantitative response measures are needed to manage the consequences of the attack and to reduce the effects on public health. These include complex and well-coordinated activities to ensure medical intervention for the prophylaxis, treatment and recovery of patients. General prophylaxis is achieved by vaccination, individual and collective CBRN protection, decontamination, partial and total sanitary treatment, microbiological analysis for the detection, identification and confirmation of the biological agent. Therapy for disease induced by weaponized B. anthracis differs from classic antrax disease regarding antibiotics, doses and time, resulting a large antibiotic consumption per case. Complete recovery of the patients is achieved not only in terms of restoring normal biological parameters, but also in terms of the organism’s "sterilisation" regarding the causal biological agent.