Background/aims: The phenotype of late relapsed hepatitis C virus (HCV) infection (RCI), defined as reappearance of serum HCV RNA in patients with sustained virological responses (SVRs) without reinfection, has yet to be fully elucidated in Asia.
Methods: This 18-year prospective study included 1004 Taiwanese SVR patients who were followed up every 3‒6 months. Assessments of late RCI were performed in patients with abnormal alanine aminotransferase levels or occult HCV infection (OCI).
Results: Among 531 SVR patients tested for OCI, 139 (26.1%) experienced OCI. Of 1004 SVR patients, 2 (0.19%) developed late RCI: one was a 57-year-old genotype 1 HCV-infected male without cirrhosis (patient A) who experienced RCI at 12 months after 12 months of combination therapy with pegylated interferon and ribavirin; the other was a 65-year-old genotype 2 HCV-infected male without cirrhosis (patient B) who experienced RCI at 63 months after 3 months of combination therapy with sofosbuvir and ribavirin and in whom OCI preceded RCI by 36 months. Patients A and B received sofosbuvir/velpatasvir therapy and achieved a 2nd SVR at 10 years and 5 years after the 1st SVR, respectively. Neither late RCI patient had cirrhosis or HCC.
Conclusions: During the 18-year follow-up, 0.199% of SVR patients and 0.188% of OCI patients developed late RCI at 1-5 years after the first SVR. In both late RCI patients, 2nd SVR was achieved using sofosbuvir/velpatasvir. Future studies with comprehensive OCI and late RCI assessments are needed to establish the precise relationships of OCI and hepatic events with late RCI.
{"title":"Evolution of late hepatitis C relapse among patients with previous sustained virological responses: An 18-year prospective study.","authors":"Wei-Ting Chen, Yi-Jyun Shen, Rong-Nan Chien, Ming-Ling Chang","doi":"10.1016/j.jgar.2026.02.006","DOIUrl":"https://doi.org/10.1016/j.jgar.2026.02.006","url":null,"abstract":"<p><strong>Background/aims: </strong>The phenotype of late relapsed hepatitis C virus (HCV) infection (RCI), defined as reappearance of serum HCV RNA in patients with sustained virological responses (SVRs) without reinfection, has yet to be fully elucidated in Asia.</p><p><strong>Methods: </strong>This 18-year prospective study included 1004 Taiwanese SVR patients who were followed up every 3‒6 months. Assessments of late RCI were performed in patients with abnormal alanine aminotransferase levels or occult HCV infection (OCI).</p><p><strong>Results: </strong>Among 531 SVR patients tested for OCI, 139 (26.1%) experienced OCI. Of 1004 SVR patients, 2 (0.19%) developed late RCI: one was a 57-year-old genotype 1 HCV-infected male without cirrhosis (patient A) who experienced RCI at 12 months after 12 months of combination therapy with pegylated interferon and ribavirin; the other was a 65-year-old genotype 2 HCV-infected male without cirrhosis (patient B) who experienced RCI at 63 months after 3 months of combination therapy with sofosbuvir and ribavirin and in whom OCI preceded RCI by 36 months. Patients A and B received sofosbuvir/velpatasvir therapy and achieved a 2<sup>nd</sup> SVR at 10 years and 5 years after the 1<sup>st</sup> SVR, respectively. Neither late RCI patient had cirrhosis or HCC.</p><p><strong>Conclusions: </strong>During the 18-year follow-up, 0.199% of SVR patients and 0.188% of OCI patients developed late RCI at 1-5 years after the first SVR. In both late RCI patients, 2<sup>nd</sup> SVR was achieved using sofosbuvir/velpatasvir. Future studies with comprehensive OCI and late RCI assessments are needed to establish the precise relationships of OCI and hepatic events with late RCI.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-20DOI: 10.1016/j.jgar.2026.02.008
Qi Ding, Longyang Jin, Ruobing Wang, Qi Wang, Hui Wang
Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP), particularly the ST11-KL64 clone carrying blaKPC-2, is a critical global health threat. This study investigates the adaptive evolution of CRKP under last-line antibiotic pressure, focusing on resistance mechanisms, genetic alterations, and associated phenotypic changes.
Methods: A serial passage laboratory evolution model was established using a triple-antibiotic combination - ceftazidime/avibactam (CZA), tigecycline (TGC), and colistin (COL) in a 4:2:1 ratio - against the ST11-KL64 CRKP strain. Six independent evolutionary lineages were generated and analyzed for resistance phenotypes, genomic mutations, and changes in fitness and virulence. Antimicrobial susceptibility testing, whole-genome sequencing, and transcriptomic analysis were employed to characterize resistance mechanisms and physiological adaptations.
Results: Evolved populations exhibited markedly increased resistance to CZA, TGC, and COL, reaching maximal antibiotic concentrations within 19-45 days. Fixed mutations were identified in the pmrAB and phoPQ two-component systems and the mgrB regulator. Plasmid-borne gene amplifications of blaSHV-12 and tet(A) were observed. Transcriptomic profiling revealed widespread gene expression reprogramming associated with resistance. Notably, evolved strains showed increased fitness costs, altered colony morphology, reduced capsule production, and attenuated virulence.
Conclusion: This study demonstrates the complex adaptive mechanisms employed by CRKP to enhance multidrug resistance. Mutations, gene amplifications, and altered gene expression underpin resistance to key antibiotics, while virulence factors are modified, likely due to fitness costs. These findings highlight the need for more effective strategies to combat the evolving threat of CRKP in clinical settings.
{"title":"Evolution of antibiotic resistance and virulence in ST11-KL64 carbapenem-resistant Klebsiella pneumoniae under last-resort antibiotic pressure.","authors":"Qi Ding, Longyang Jin, Ruobing Wang, Qi Wang, Hui Wang","doi":"10.1016/j.jgar.2026.02.008","DOIUrl":"10.1016/j.jgar.2026.02.008","url":null,"abstract":"<p><strong>Objectives: </strong>Carbapenem-resistant Klebsiella pneumoniae (CRKP), particularly the ST11-KL64 clone carrying bla<sub>KPC-2</sub>, is a critical global health threat. This study investigates the adaptive evolution of CRKP under last-line antibiotic pressure, focusing on resistance mechanisms, genetic alterations, and associated phenotypic changes.</p><p><strong>Methods: </strong>A serial passage laboratory evolution model was established using a triple-antibiotic combination - ceftazidime/avibactam (CZA), tigecycline (TGC), and colistin (COL) in a 4:2:1 ratio - against the ST11-KL64 CRKP strain. Six independent evolutionary lineages were generated and analyzed for resistance phenotypes, genomic mutations, and changes in fitness and virulence. Antimicrobial susceptibility testing, whole-genome sequencing, and transcriptomic analysis were employed to characterize resistance mechanisms and physiological adaptations.</p><p><strong>Results: </strong>Evolved populations exhibited markedly increased resistance to CZA, TGC, and COL, reaching maximal antibiotic concentrations within 19-45 days. Fixed mutations were identified in the pmrAB and phoPQ two-component systems and the mgrB regulator. Plasmid-borne gene amplifications of bla<sub>SHV-12</sub> and tet(A) were observed. Transcriptomic profiling revealed widespread gene expression reprogramming associated with resistance. Notably, evolved strains showed increased fitness costs, altered colony morphology, reduced capsule production, and attenuated virulence.</p><p><strong>Conclusion: </strong>This study demonstrates the complex adaptive mechanisms employed by CRKP to enhance multidrug resistance. Mutations, gene amplifications, and altered gene expression underpin resistance to key antibiotics, while virulence factors are modified, likely due to fitness costs. These findings highlight the need for more effective strategies to combat the evolving threat of CRKP in clinical settings.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":"24-34"},"PeriodicalIF":3.2,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study determines the prevalence and genomic characterisation of uropathogens causing community-acquired urinary tract infections.
Materials and methods: This is a first multicentric cross-sectional community study conducted across different regions of India, in patients aged >1.5 y suspected with urinary tract infection. Uropathogens causing significant bacteriuria were identified, and susceptibility testing was performed. Whole-genome sequencing was done to characterise antimicrobial resistance genes, virulence genes, and sequence types (ST). The effect of age and gender on significant bacteriuria was assessed by Multivariable random-effects logistic regression.
Results: Significant bacteriuria was seen in 11.8% (711/6009) of the specimens, out of which 63% (448/711) were Escherichia coli, and 15.7% (112/711) were Klebsiella pneumoniae. The prevalence of extended-spectrum beta-lactamase positive, multidrug-resistant and carbapenem resistant E. coli was 65.4% (293/448), 64.5% (289/448) and 9.8% (44/448); among K. pneumoniae isolates, similar resistance was seen in 56.2% (63/112), 39.2% (44/112), and 9.8% (11/112), respectively. Genomic analysis showed high-risk clones of E. coli (ST131, ST1193) and K. pneumoniae (ST15, ST16, and ST231) carrying multiple plasmids with blaCTX-M-15, blaOXA-232, blaNDM-5, and blaNDM-7 genes.
Conclusions: This study revealed a wider presence of drug-resistant high-risk clones of uropathogens in community settings of India. A multifaceted approach through routine antimicrobial resistance surveillance, judicious choice of empiric antibiotics in a community setting, is deemed necessary. Whole-genome sequencing analysis of extended-spectrum beta-lactamase-producing E. coli isolates revealed a predominance of ST131 lineage (25%), while ST1193 strains carried IncFIA and ColKP3 plasmids associated with blaCTX-M-15 and blaTEM-1B. ST231 K. pneumoniae isolates harboured blaOXA-32 gene along with ColKP3 plasmid.
{"title":"Phenotypic and genotypic characterization of antimicrobial-resistant uropathogens in community settings of India: A multicentric cross-sectional study.","authors":"Sarita Mohapatra, Swati Pundir, Rajashree Panigrahy, Shwetha Venugopal, Sneha Chunchanur, Vibhor Tak, Dibyabhaba Pradhan, Mani Kalaivani, Manisha Yadav, Bimal Kumar Das, Hitender Gautam, Seema Sood, Arvind Kumar, Rajesh Kumari, Harshal Ramesh Salve, Sumit Malhotra, Pankaj Hari, Shashi Kant, Arti Kapil, Susmita Chaudhuri","doi":"10.1016/j.jgar.2026.02.003","DOIUrl":"10.1016/j.jgar.2026.02.003","url":null,"abstract":"<p><strong>Objective: </strong>This study determines the prevalence and genomic characterisation of uropathogens causing community-acquired urinary tract infections.</p><p><strong>Materials and methods: </strong>This is a first multicentric cross-sectional community study conducted across different regions of India, in patients aged >1.5 y suspected with urinary tract infection. Uropathogens causing significant bacteriuria were identified, and susceptibility testing was performed. Whole-genome sequencing was done to characterise antimicrobial resistance genes, virulence genes, and sequence types (ST). The effect of age and gender on significant bacteriuria was assessed by Multivariable random-effects logistic regression.</p><p><strong>Results: </strong>Significant bacteriuria was seen in 11.8% (711/6009) of the specimens, out of which 63% (448/711) were Escherichia coli, and 15.7% (112/711) were Klebsiella pneumoniae. The prevalence of extended-spectrum beta-lactamase positive, multidrug-resistant and carbapenem resistant E. coli was 65.4% (293/448), 64.5% (289/448) and 9.8% (44/448); among K. pneumoniae isolates, similar resistance was seen in 56.2% (63/112), 39.2% (44/112), and 9.8% (11/112), respectively. Genomic analysis showed high-risk clones of E. coli (ST131, ST1193) and K. pneumoniae (ST15, ST16, and ST231) carrying multiple plasmids with bla<sub>CTX-M-15</sub>, bla<sub>OXA-232</sub>, bla<sub>NDM-5</sub>, and bla<sub>NDM-7</sub> genes.</p><p><strong>Conclusions: </strong>This study revealed a wider presence of drug-resistant high-risk clones of uropathogens in community settings of India. A multifaceted approach through routine antimicrobial resistance surveillance, judicious choice of empiric antibiotics in a community setting, is deemed necessary. Whole-genome sequencing analysis of extended-spectrum beta-lactamase-producing E. coli isolates revealed a predominance of ST131 lineage (25%), while ST1193 strains carried IncFIA and ColKP3 plasmids associated with bla<sub>CTX-M-15</sub> and bla<sub>TEM-1B</sub>. ST231 K. pneumoniae isolates harboured bla<sub>OXA-32</sub> gene along with ColKP3 plasmid.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":"35-43"},"PeriodicalIF":3.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Plasmid-mediaed tet(X4), linked to high-level tigecycline resistance, was first identified in China with Escherichia coli (E. coli) as a major reservoir. No confirmed cases had been reported in Taiwan.
Methods: We examined 81 tigecycline-resistant E. coli isolates (MIC ≥ 4 mg/L) collected in Taiwan from 2015 to 2022, including 71.6% carbapenem-resistant and 28.4% carbapenem-susceptible strains. Thirty-six underwent whole-genome sequencing to investigate resistance mechanisms.
Results: Two isolates (2.5%) carried tet(X4) on novel plasmids (pEC1360-1 and pEC1638-1). Both plasmids contained the ISVsa3-estT-tet(X4)-ISVsa3 (IETI) element, a mobile unit capable of transposon-mediated transfer without a fixed integration hotspot. The tet(X4)-positive strains showed distinct evolutionary divergence from the first reported Chinese strain (LHM10-1). Tet(X4) was located on different Inc-type plasmids, including a 66.8 kb IncR and a 159.3 kb IncR/IncFIB(K)/IncFIA(HI1) plasmid, across various sequence types. No tet(X4) was detected in carbapenem-resistant isolates. Other resistance genes, such as cmlA1 and floR, were more prevalent in carbapenem-susceptible isolates (66.7% vs. 25.9%, P = 0.077).
Conclusion: This study reports the first tet(X4)-positive E. coli isolates in Taiwan, both from carbapenem-susceptible strains. The presence of novel mobile plasmids underscores the potential for horizontal gene transfer. Continuous surveillance of tet(X) and other last-line antibiotic resistance mechanisms is essential to mitigate the risk of further spread.
背景：质粒介导的tet（X4）与高水平的替加环素耐药性有关，首次在中国被发现，大肠杆菌（E. coli）是主要宿主。台湾尚未报告确诊病例。方法：对2015-2022年在台湾地区采集的81株耐替加环素大肠杆菌（MIC≥4 mg/L）进行检测，其中碳青霉烯耐药菌株71.6%，敏感菌株28.4%。36例进行了全基因组测序以研究耐药机制。结果：两个分离株（2.5%）在新的质粒pEC1360-1和pEC1638-1上携带tet（X4）。这两个质粒都含有ISVsa3-estT-tet(X4)-ISVsa3 （IETI）元件，这是一个移动单元，能够进行转座子介导的转移，没有固定的整合热点。tet（X4）阳性菌株与首次报道的中国菌株（LHM10-1）存在明显的进化差异。Tet（X4）位于不同的inctype质粒上，包括66.8 kb IncR和159.3 kb IncR/IncFIB(K)/IncFIA（HI1）质粒，跨越不同的序列类型。碳青霉烯耐药菌株未检出tet（X4）。其他耐药基因如cmlA1和floR在碳青霉烯类敏感菌株中更为普遍（66.7% vs. 25.9%, P = 0.077）。结论：本研究报道了台湾首次从碳青霉烯类敏感菌株中分离到tet（X4）阳性大肠杆菌。新的移动质粒的存在强调了水平基因转移的潜力。持续监测tet(X)和其他最后一线抗生素耐药机制对于减轻进一步传播的风险至关重要。
{"title":"Tet(X4)-producing Escherichia coli isolates in Taiwan.","authors":"Wen-Chun Huang, Yu-Tsung Huang, Wen-Chien Ko, Wei-An Shih, Ching-Hao Teng, Jiun-Ling Wang","doi":"10.1016/j.jgar.2026.01.014","DOIUrl":"10.1016/j.jgar.2026.01.014","url":null,"abstract":"<p><strong>Objectives: </strong>Plasmid-mediaed tet(X4), linked to high-level tigecycline resistance, was first identified in China with Escherichia coli (E. coli) as a major reservoir. No confirmed cases had been reported in Taiwan.</p><p><strong>Methods: </strong>We examined 81 tigecycline-resistant E. coli isolates (MIC ≥ 4 mg/L) collected in Taiwan from 2015 to 2022, including 71.6% carbapenem-resistant and 28.4% carbapenem-susceptible strains. Thirty-six underwent whole-genome sequencing to investigate resistance mechanisms.</p><p><strong>Results: </strong>Two isolates (2.5%) carried tet(X4) on novel plasmids (pEC1360-1 and pEC1638-1). Both plasmids contained the ISVsa3-estT-tet(X4)-ISVsa3 (IETI) element, a mobile unit capable of transposon-mediated transfer without a fixed integration hotspot. The tet(X4)-positive strains showed distinct evolutionary divergence from the first reported Chinese strain (LHM10-1). Tet(X4) was located on different Inc-type plasmids, including a 66.8 kb IncR and a 159.3 kb IncR/IncFIB(K)/IncFIA(HI1) plasmid, across various sequence types. No tet(X4) was detected in carbapenem-resistant isolates. Other resistance genes, such as cmlA1 and floR, were more prevalent in carbapenem-susceptible isolates (66.7% vs. 25.9%, P = 0.077).</p><p><strong>Conclusion: </strong>This study reports the first tet(X4)-positive E. coli isolates in Taiwan, both from carbapenem-susceptible strains. The presence of novel mobile plasmids underscores the potential for horizontal gene transfer. Continuous surveillance of tet(X) and other last-line antibiotic resistance mechanisms is essential to mitigate the risk of further spread.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":"44-57"},"PeriodicalIF":3.2,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-02DOI: 10.1016/j.jgar.2025.11.015
João Pedro Rueda Furlan , Rafael da Silva Rosa , Micaela Santana Ramos , Lucas David Rodrigues dos Santos , Eliana Guedes Stehling
{"title":"Terrestrial plastisphere as a reservoir of high-risk mcr-1-positive Escherichia coli ST744 in a farmhouse","authors":"João Pedro Rueda Furlan , Rafael da Silva Rosa , Micaela Santana Ramos , Lucas David Rodrigues dos Santos , Eliana Guedes Stehling","doi":"10.1016/j.jgar.2025.11.015","DOIUrl":"10.1016/j.jgar.2025.11.015","url":null,"abstract":"","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 146-147"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145677860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-22DOI: 10.1016/j.jgar.2025.12.001
Sudha Chandrashekar , Shambhavi Nimisha Prasad , Ramesh Masthi N R , Sheilja Walia , Anushree Trikha , Rajeev Sadanandan
Background
Antimicrobial resistance (AMR) poses a formidable threat to public health in India, requiring a multidimensional response that bridges policy, innovation and intersectoral collaborations. The rapid emergence and spread of multidrug-resistant pathogens driven by the misuse of antimicrobials in human health, animal health, agriculture and environmental settings has rendered many existing therapies obsolete, leaving the population vulnerable to untreatable infections.
Objectives
To examine the multifactorial drivers of AMR in India, review current national and state-level policies and explore the potential role of artificial intelligence (AI) in AMR surveillance, prevention and control.
Methods
This review synthesises evidence from published literature, reports and policy documents. It analyses AMR determinants across human, animal and environmental sectors, evaluates policy frameworks such as India’s National Action Plan and State Action Plans to combat AMR.
Results
Key AMR drivers include antibiotic misuse, inadequate regulation, over-the-counter availability, pharmaceutical and hospital wastewater contamination and gaps in infection prevention. India has come up with national and six state level action plans for AMR containment. The measures include stewardship programs, laboratory network strengthening, spreading awareness and intersectoral coordination. The role of AI in strengthening AMR surveillance and clinical decision-making by integrating complex, high-dimensional data for predictive modelling has been explored.
Conclusion
While India has made significant policy and surveillance advances, enforcement gaps, limited awareness and fragmented data hinder progress. Strengthening governance, expanding One Health surveillance, integrating AI and embedding AMR strategies into universal health coverage are critical to mitigating AMR’s health and economic burden.
{"title":"Antimicrobial resistance in India: Integrating the response into health systems for universal health coverage","authors":"Sudha Chandrashekar , Shambhavi Nimisha Prasad , Ramesh Masthi N R , Sheilja Walia , Anushree Trikha , Rajeev Sadanandan","doi":"10.1016/j.jgar.2025.12.001","DOIUrl":"10.1016/j.jgar.2025.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial resistance (AMR) poses a formidable threat to public health in India, requiring a multidimensional response that bridges policy, innovation and intersectoral collaborations. The rapid emergence and spread of multidrug-resistant pathogens driven by the misuse of antimicrobials in human health, animal health, agriculture and environmental settings has rendered many existing therapies obsolete, leaving the population vulnerable to untreatable infections.</div></div><div><h3>Objectives</h3><div>To examine the multifactorial drivers of AMR in India, review current national and state-level policies and explore the potential role of artificial intelligence (AI) in AMR surveillance, prevention and control.</div></div><div><h3>Methods</h3><div>This review synthesises evidence from published literature, reports and policy documents. It analyses AMR determinants across human, animal and environmental sectors, evaluates policy frameworks such as India’s National Action Plan and State Action Plans to combat AMR.</div></div><div><h3>Results</h3><div>Key AMR drivers include antibiotic misuse, inadequate regulation, over-the-counter availability, pharmaceutical and hospital wastewater contamination and gaps in infection prevention. India has come up with national and six state level action plans for AMR containment. The measures include stewardship programs, laboratory network strengthening, spreading awareness and intersectoral coordination. The role of AI in strengthening AMR surveillance and clinical decision-making by integrating complex, high-dimensional data for predictive modelling has been explored.</div></div><div><h3>Conclusion</h3><div>While India has made significant policy and surveillance advances, enforcement gaps, limited awareness and fragmented data hinder progress. Strengthening governance, expanding One Health surveillance, integrating AI and embedding AMR strategies into universal health coverage are critical to mitigating AMR’s health and economic burden.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 195-202"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-22DOI: 10.1016/j.jgar.2025.12.013
Eriko Hashimoto , Sayaka Yoshida , Taito Kitano
Purpose
Although the non-inferiority of adjunctive linezolid (LZD) was indicated for the treatment of invasive group A streptococcal (iGAS) infection, compared with adjunctive clindamycin (CLDM), additional evaluation of comparative effectiveness by subpopulation may further strengthen the evidence. We compared the efficacy of CLDM and LZD combination therapy for iGAS infection.
Methods
In this retrospective cohort study, data were extracted and analysed using TriNetX, a multicentre database. Data were extracted from 1 January 2015 to 30 April 2025, creating two cohorts (adjunctive CLDM and LZD groups). The primary endpoint was mortality within 90 d from diagnosis, which was compared between groups using propensity score matching. Subgroup analyses were conducted according to age, concomitant intravenous immunoglobulin treatment, and study period.
Results
For analysis, 5841 cases were identified in the CLDM combination group and 1426 in the LZD group. The primary endpoint was observed in 170 (12.0%) cases in the CLDM group and 195 (13.8%) in the LZD group. Odds ratio was 0.854 (95% confidence interval 0.685–1.065, P = 0.161), with odds ratio <1 indicating a CLDM-favourable result.
Conclusions
Clinical efficacy of adjunctive CLDM and LZD was compared in patients with iGAS infection. No significant difference in mortality was observed in the overall population. LZD may be a potential alternative in cases where CLDM use is limited by resistance, intolerance, or contraindications.
{"title":"Clinical outcome comparison between adjunctive clindamycin vs. linezolid for invasive group A streptococcal infection","authors":"Eriko Hashimoto , Sayaka Yoshida , Taito Kitano","doi":"10.1016/j.jgar.2025.12.013","DOIUrl":"10.1016/j.jgar.2025.12.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Although the non-inferiority of adjunctive linezolid (LZD) was indicated for the treatment of invasive group A streptococcal (iGAS) infection, compared with adjunctive clindamycin (CLDM), additional evaluation of comparative effectiveness by subpopulation may further strengthen the evidence. We compared the efficacy of CLDM and LZD combination therapy for iGAS infection.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, data were extracted and analysed using TriNetX, a multicentre database. Data were extracted from 1 January 2015 to 30 April 2025, creating two cohorts (adjunctive CLDM and LZD groups). The primary endpoint was mortality within 90 d from diagnosis, which was compared between groups using propensity score matching. Subgroup analyses were conducted according to age, concomitant intravenous immunoglobulin treatment, and study period.</div></div><div><h3>Results</h3><div>For analysis, 5841 cases were identified in the CLDM combination group and 1426 in the LZD group. The primary endpoint was observed in 170 (12.0%) cases in the CLDM group and 195 (13.8%) in the LZD group. Odds ratio was 0.854 (95% confidence interval 0.685–1.065, <em>P</em> = 0.161), with odds ratio <1 indicating a CLDM-favourable result.</div></div><div><h3>Conclusions</h3><div>Clinical efficacy of adjunctive CLDM and LZD was compared in patients with iGAS infection. No significant difference in mortality was observed in the overall population. LZD may be a potential alternative in cases where CLDM use is limited by resistance, intolerance, or contraindications.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 241-245"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to investigate sulbactam-durlobactam (SUL-DUR) susceptibility and molecular features of carbapenem-resistant Acinetobacter baumannii (CRAB) isolates from a Shenzhen teaching hospital.
Methods
A retrospective study on CRAB was conducted from January 2018 to June 2025. Isolates were screened for gyrB and β-lactamase genes (blaOXA-23, −24, −51, and −58). Multi-locus sequence typing (MLST) was used for genotyping, and SUL-DUR susceptibility was tested by disk diffusion. The SUL-DUR-resistant isolate underwent whole-genome sequencing to identify resistance mechanisms.
Results
Of 741 non-duplicate A. baumannii isolates, 147 were CRAB, with its annual percentage rising from 11.4% (2018) to 47.2% (2025). Most isolates came from the ICU (53.7%), and affected patients were predominantly aged ≥60 years (62.6%). Sputum was the primary source (49.7%). Resistance rates exceeded 90% for multiple antibiotics, but only one isolate (0.7%) was resistant to SUL-DUR. This strain harbored nine resistance genes (including blaOXA-23 and blaOXA-66) and had substitutions in penicillin-binding protein 2 (PBP2) and a putative D-Ala-D-Ala carboxypeptidase.
Five sequence types (STs) were identified, including ST2, ST877, ST133, ST195, and a novel sequence type (ST3267), with ST2 being predominant (96.6%). The blaOXA-23 gene was present in 72.8% of isolates, while blaOXA-24 was rare (2.7%). All isolates carried intrinsic blaOXA-51 and gyrB, but blaOXA-58 was absent.
Conclusions
The increasing percentage of carbapenem-resistance among A. baumannii, dominated by ST2 and blaOXA-23-positive strains, highlights an urgent need for stricter infection control. Meanwhile, the notable in vitro susceptibility of CRAB to SUL-DUR offers a promising therapeutic alternative for patients infected with CRAB.
{"title":"The epidemiological and molecular characteristics and sulbactam-durlobactam susceptibility of carbapenem-resistant Acinetobacter baumannii in a Chinese teaching hospital","authors":"Hanlian Huang , Qiaomin Zhang , Shaobo Li , Xiaoyan Dai, Zhongbiao Chen, Guili Zhang, Wen Ma, Hongwei Shen","doi":"10.1016/j.jgar.2025.12.003","DOIUrl":"10.1016/j.jgar.2025.12.003","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to investigate sulbactam-durlobactam (SUL-DUR) susceptibility and molecular features of carbapenem-resistant <em>Acinetobacter baumannii</em> (CRAB) isolates from a Shenzhen teaching hospital.</div></div><div><h3>Methods</h3><div>A retrospective study on CRAB was conducted from January 2018 to June 2025. Isolates were screened for <em>gyrB</em> and β-lactamase genes (<em>bla</em>OXA-23, −24, −51, and −58). Multi-locus sequence typing (MLST) was used for genotyping, and SUL-DUR susceptibility was tested by disk diffusion. The SUL-DUR-resistant isolate underwent whole-genome sequencing to identify resistance mechanisms.</div></div><div><h3>Results</h3><div>Of 741 non-duplicate <em>A. baumannii</em> isolates, 147 were CRAB, with its annual percentage rising from 11.4% (2018) to 47.2% (2025). Most isolates came from the ICU (53.7%), and affected patients were predominantly aged ≥60 years (62.6%). Sputum was the primary source (49.7%). Resistance rates exceeded 90% for multiple antibiotics, but only one isolate (0.7%) was resistant to SUL-DUR. This strain harbored nine resistance genes (including <em>bla</em>OXA-23 and <em>bla</em>OXA-66) and had substitutions in penicillin-binding protein 2 (PBP2) and a putative D-Ala-D-Ala carboxypeptidase.</div><div>Five sequence types (STs) were identified, including ST2, ST877, ST133, ST195, and a novel sequence type (ST3267), with ST2 being predominant (96.6%). The <em>bla</em>OXA-23 gene was present in 72.8% of isolates, while <em>bla</em>OXA-24 was rare (2.7%). All isolates carried intrinsic <em>bla</em>OXA-51 and <em>gyrB</em>, but <em>bla</em>OXA-58 was absent.</div></div><div><h3>Conclusions</h3><div>The increasing percentage of carbapenem-resistance among <em>A. baumannii</em>, dominated by ST2 and <em>bla</em>OXA-23-positive strains, highlights an urgent need for stricter infection control. Meanwhile, the notable <em>in vitro</em> susceptibility of CRAB to SUL-DUR offers a promising therapeutic alternative for patients infected with CRAB.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 137-145"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-29DOI: 10.1016/j.jgar.2025.11.018
Jin Seok Kim , Young Hee Jin , So Youn Park , Hyo-Won Jeong , Jinwoo Kim , Sook Hyun Park , Chang-Kyu Kim , YoungAh Yoo , Young Kyung Yoon , Jae In Lee , Jihun Jung , Ju-Sung Park
Objective
Raoultella ornithinolytica is recognized as an emerging opportunistic pathogen, with sporadic reports of multidrug resistance. However, comprehensive analyses of carbapenem-resistant isolates remain limited. This study investigated the molecular features and plasmid-mediated transmission of blaNDM-1 among clonally distinct clinical isolates of R. ornithinolytica in Seoul, South Korea.
Methods
All 13 carbapenem-resistant R. ornithinolytica isolates referred to the central reference laboratory in Seoul from seven hospitals between 2018 and 2020 were analysed. Isolates were characterized using antimicrobial susceptibility testing, resistance gene detection, plasmid replicon typing, pulsed-field gel electrophoresis, conjugation assays, and whole-genome sequencing.
Results
Among the 13 isolates, 10 harboured blaNDM-1, seven of which carried the gene on IncX3 plasmids. Despite clonal diversity, six of the 13 isolates shared nearly identical transferable IncX3 plasmids of approximately 45 kb, indicating horizontal plasmid dissemination among non-clonal strains. A novel blaNDM-1 configuration, IS3000–∆ISAba125–IS1A–blaNDM-1–bleMBL–trpF, was found in both R. ornithinolytica and Enterobacter cloacae from a single hospital, including two patients with co-infection. These findings highlighting the key role of IncX3 plasmids in rapid dissemination of blaNDM-1 across species boundaries.
Conclusions
This study demonstrates the contribution of IncX3 plasmids to the intra- and interspecies spread of blaNDM-1, underscoring the need for enhanced genomic surveillance of emerging pathogens such as R. ornithinolytica to limit carbapenem resistance transmission in clinical settings.
{"title":"Clonal diversity and plasmid-mediated emergence of NDM-1-producing Raoultella ornithinolytica in clinical isolates","authors":"Jin Seok Kim , Young Hee Jin , So Youn Park , Hyo-Won Jeong , Jinwoo Kim , Sook Hyun Park , Chang-Kyu Kim , YoungAh Yoo , Young Kyung Yoon , Jae In Lee , Jihun Jung , Ju-Sung Park","doi":"10.1016/j.jgar.2025.11.018","DOIUrl":"10.1016/j.jgar.2025.11.018","url":null,"abstract":"<div><h3>Objective</h3><div><em>Raoultella ornithinolytica</em> is recognized as an emerging opportunistic pathogen, with sporadic reports of multidrug resistance. However, comprehensive analyses of carbapenem-resistant isolates remain limited. This study investigated the molecular features and plasmid-mediated transmission of <em>bla</em><sub>NDM-1</sub> among clonally distinct clinical isolates of <em>R. ornithinolytica</em> in Seoul, South Korea.</div></div><div><h3>Methods</h3><div>All 13 carbapenem-resistant <em>R. ornithinolytica</em> isolates referred to the central reference laboratory in Seoul from seven hospitals between 2018 and 2020 were analysed. Isolates were characterized using antimicrobial susceptibility testing, resistance gene detection, plasmid replicon typing, pulsed-field gel electrophoresis, conjugation assays, and whole-genome sequencing.</div></div><div><h3>Results</h3><div>Among the 13 isolates, 10 harboured <em>bla</em><sub>NDM-1</sub>, seven of which carried the gene on IncX3 plasmids. Despite clonal diversity, six of the 13 isolates shared nearly identical transferable IncX3 plasmids of approximately 45 kb, indicating horizontal plasmid dissemination among non-clonal strains. A novel <em>bla</em><sub>NDM-1</sub> configuration, IS<em>3000</em>–∆IS<em>Aba125</em>–IS<em>1A</em>–<em>bla</em><sub>NDM-1</sub>–<em>ble</em><sub>MBL</sub>–<em>trpF</em>, was found in both <em>R. ornithinolytica</em> and <em>Enterobacter cloacae</em> from a single hospital, including two patients with co-infection. These findings highlighting the key role of IncX3 plasmids in rapid dissemination of <em>bla</em><sub>NDM-1</sub> across species boundaries.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the contribution of IncX3 plasmids to the intra- and interspecies spread of <em>bla</em><sub>NDM-1</sub>, underscoring the need for enhanced genomic surveillance of emerging pathogens such as <em>R. ornithinolytica</em> to limit carbapenem resistance transmission in clinical settings.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 132-136"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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