Pub Date : 2026-01-01Epub Date: 2025-11-17DOI: 10.1016/j.jgar.2025.11.006
Jinjin Zhang , Ruyin Zhou , Jingru Ren , Ziping Wu , Jianzhong Shen , Yang Wang , Shenggen Fan , Xiangming Fang
Background
The resistance rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) resistance rate has risen by 20% over the past 19 y in China. The socioeconomic burden of CRKP infections has rarely been estimated.
Methods
We estimated the number of CRKP-infected inpatients, the disability-adjusted life-years lost, and the socioeconomic burden in China in 2019. Using national surveillance data (China Antimicrobial Surveillance System), published literature, and official statistics, we adapted Cassini’s disease progression model to the Chinese context to quantify the clinical and economic impact. Sensitivity analyses were adjusted for retirement age and age-specific mortality.
Results
In 2019, an estimated 263 000 inpatients had CRKP infections, resulting in 0.72 million disability-adjusted life-years lost (2.73 per patient). Direct medical costs reached $0.61 billion, indirect costs $3.85 billion, totalling $4.46 billion (0.03% of 2019 GDP). Median annual cost per patient was $16 940.
Conclusions
CRKP infections impose significant health and economic burden on China. Enhanced infection control, antimicrobial stewardship, and investment in rapid diagnostics and novel therapeutics are urgently needed. The methodology used in this study can also support burden assessments for other resistant pathogens in similar contexts.
{"title":"Economic burden of carbapenem-resistant Klebsiella pneumoniae infections in Chinese hospitals: A 2019 analysis","authors":"Jinjin Zhang , Ruyin Zhou , Jingru Ren , Ziping Wu , Jianzhong Shen , Yang Wang , Shenggen Fan , Xiangming Fang","doi":"10.1016/j.jgar.2025.11.006","DOIUrl":"10.1016/j.jgar.2025.11.006","url":null,"abstract":"<div><h3>Background</h3><div>The resistance rate of carbapenem-resistant <em>Klebsiella pneumoniae</em> (CRKP) resistance rate has risen by 20% over the past 19 y in China. The socioeconomic burden of CRKP infections has rarely been estimated.</div></div><div><h3>Methods</h3><div>We estimated the number of CRKP-infected inpatients, the disability-adjusted life-years lost, and the socioeconomic burden in China in 2019. Using national surveillance data (China Antimicrobial Surveillance System), published literature, and official statistics, we adapted Cassini’s disease progression model to the Chinese context to quantify the clinical and economic impact. Sensitivity analyses were adjusted for retirement age and age-specific mortality.</div></div><div><h3>Results</h3><div>In 2019, an estimated 263 000 inpatients had CRKP infections, resulting in 0.72 million disability-adjusted life-years lost (2.73 per patient). Direct medical costs reached $0.61 billion, indirect costs $3.85 billion, totalling $4.46 billion (0.03% of 2019 GDP). Median annual cost per patient was $16 940.</div></div><div><h3>Conclusions</h3><div>CRKP infections impose significant health and economic burden on China. Enhanced infection control, antimicrobial stewardship, and investment in rapid diagnostics and novel therapeutics are urgently needed. The methodology used in this study can also support burden assessments for other resistant pathogens in similar contexts.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 63-70"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556996","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: 2025-11-15DOI: 10.1016/j.jgar.2025.11.009
Wei Li , Wenguang Xiong , Junzhuo Guo , Na Sun , Zhenling Zeng
Objective
Animal-derived Staphylococcus aureus frequently exhibits multidrug resistance, with complex and diverse resistance mechanisms that have raised significant public health concerns. The objective of this study was to determine the prevalence of S. aureus in swine farms and evaluate its antimicrobial resistance and distribution of oxazolidinone resistance genes.
Methods
The swine samples were collected on 17 swine farms from four provinces in China. All S. aureus isolates were screened for cfr, optrA, and poxtA. Whole-genome sequencing of cfr-positive strains revealed their molecular characteristics. All cfr-positive isolates were subjected to antimicrobial susceptibility testing.
Results
A total of 302 swine-derived S. aureus were collected from 4973 samples. Seven cfr-positive S. aureus strains, including four ST1-t4792 MSSA, two ST9-t4358 MSSA, and one ST398-t034 MRSA, were identified by whole-genome sequencing. Antimicrobial susceptibility testing against 23 agents from 12 classes revealed that all cfr-positive strains were resistant to penicillin, ampicillin, erythromycin, tetracycline, doxycycline, clindamycin, florfenicol, tiamulin, and valnemulin. Six MSSA strains additionally exhibited resistance to gentamicin, kanamycin, and ciprofloxacin, while three strains showed resistance to tilmicosin, ciprofloxacin, and trimethoprim-sulfamethoxazole. Third-generation sequencing of a strain co-harbouring cfr and fosD demonstrated that both genes were located on a plasmid also carrying fexA and aadD.
Conclusions
This study revealed the presence of the cfr gene across diverse multilocus sequence typing types of S. aureus and highlighted the co-dissemination of cfr with fosD and other resistance genes via plasmids in S. aureus. Based on One Health principles and risk of multidrug resistance spread, continuous surveillance of animal-derived S. aureus was urgently needed.
{"title":"Prevalence of the cfr gene and co-dissemination with the fosD gene in swine-derived Staphylococcus aureus","authors":"Wei Li , Wenguang Xiong , Junzhuo Guo , Na Sun , Zhenling Zeng","doi":"10.1016/j.jgar.2025.11.009","DOIUrl":"10.1016/j.jgar.2025.11.009","url":null,"abstract":"<div><h3>Objective</h3><div>Animal-derived <em>Staphylococcus aureus</em> frequently exhibits multidrug resistance, with complex and diverse resistance mechanisms that have raised significant public health concerns. The objective of this study was to determine the prevalence of <em>S. aureus</em> in swine farms and evaluate its antimicrobial resistance and distribution of oxazolidinone resistance genes.</div></div><div><h3>Methods</h3><div>The swine samples were collected on 17 swine farms from four provinces in China. All <em>S. aureus</em> isolates were screened for <em>cfr, optrA</em>, and <em>poxtA</em>. Whole-genome sequencing of <em>cfr</em>-positive strains revealed their molecular characteristics. All <em>cfr</em>-positive isolates were subjected to antimicrobial susceptibility testing.</div></div><div><h3>Results</h3><div>A total of 302 swine-derived <em>S. aureus</em> were collected from 4973 samples. Seven <em>cfr</em>-positive <em>S. aureus</em> strains, including four ST1-t4792 MSSA, two ST9-t4358 MSSA, and one ST398-t034 MRSA, were identified by whole-genome sequencing. Antimicrobial susceptibility testing against 23 agents from 12 classes revealed that all <em>cfr</em>-positive strains were resistant to penicillin, ampicillin, erythromycin, tetracycline, doxycycline, clindamycin, florfenicol, tiamulin, and valnemulin. Six MSSA strains additionally exhibited resistance to gentamicin, kanamycin, and ciprofloxacin, while three strains showed resistance to tilmicosin, ciprofloxacin, and trimethoprim-sulfamethoxazole. Third-generation sequencing of a strain co-harbouring <em>cfr</em> and <em>fosD</em> demonstrated that both genes were located on a plasmid also carrying <em>fexA</em> and <em>aadD</em>.</div></div><div><h3>Conclusions</h3><div>This study revealed the presence of the <em>cfr</em> gene across diverse multilocus sequence typing types of <em>S. aureus</em> and highlighted the co-dissemination of <em>cfr</em> with <em>fosD</em> and other resistance genes via plasmids in <em>S. aureus</em>. Based on One Health principles and risk of multidrug resistance spread, continuous surveillance of animal-derived <em>S. aureus</em> was urgently needed.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 57-62"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540978","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: 2025-11-05DOI: 10.1016/j.jgar.2025.10.024
Fumin Xue , Jiangshan Hou , Chao An , Jing Yu , Fang Zhou , Bo Sun , Cong Ding , Qiang Zhou
Objective
To investigate the antibiotic resistance profile of Helicobacter pylori (H. pylori) strains and the CYP2C19 gene polymorphisms in initial eradication failure children from Henan, China (2019–2024).
Methods
A retrospective cohort study included 207 children diagnosed with H. pylori infection by gastric mucosal histopathology. Participants were categorized by endoscopic findings: normal mucosa (NM), gastritis (GA), or peptic ulcer disease (PUD). Antimicrobial susceptibility testing was performed for amoxicillin (AML), furazolidone (FZD), metronidazole (MTZ), clarithromycin (CLA), tetracycline (TET), and levofloxacin (LEV). CYP2C19 genotyping was conducted via PCR.
Results
The annual number of cases increased from 13 in 2019 to 75 in 2024. Abdominal pain (89.4%) and loss of appetite (74.9%) were the most common symptoms. Endoscopic findings were primarily GA (57.0%). Resistance to FZD and TET was undetected (0%), and AML resistance was low (1.45%). High resistance rates were observed for MTZ (75.85%), CLA (75.36%), and LEV (22.22%). Dual MTZ+CLA resistance reached 61.35%, with the highest rate (18.1%) among 13-y-olds. Triple resistance (MTZ+CLA+LEV) was 16.43%. Both single and multidrug resistance increased significantly over time (P < 0.05). CYP2C19 genotyping revealed extensive metabolizers (EM, *1/*1) in 48.33%, intermediate metabolizers (IM, *1/*2+*1/*3) in 45.00%, and poor metabolizers (PM, *2/*2+*2/*3) in 6.67%.
Conclusions
The high resistance rates to MTZ and CLA, coupled with the CYP2C19 EM phenotype, may contribute to the failure of initial empirical H. pylori eradication in children from Henan, China. Therefore, for retreatment, it is recommended to tailor an individualized regimen based on antimicrobial susceptibility testing and CYP2C19 genotyping results.
{"title":"Helicobacter pylori antimicrobial resistance and CYP2C19 genotypes in a paediatric cohort with initial eradication failure: A study from Henan, China (2019–2024)","authors":"Fumin Xue , Jiangshan Hou , Chao An , Jing Yu , Fang Zhou , Bo Sun , Cong Ding , Qiang Zhou","doi":"10.1016/j.jgar.2025.10.024","DOIUrl":"10.1016/j.jgar.2025.10.024","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the antibiotic resistance profile of <em>Helicobacter pylori</em> (<em>H. pylori</em>) strains and the CYP2C19 gene polymorphisms in initial eradication failure children from Henan, China (2019–2024).</div></div><div><h3>Methods</h3><div>A retrospective cohort study included 207 children diagnosed with <em>H. pylori</em> infection by gastric mucosal histopathology. Participants were categorized by endoscopic findings: normal mucosa (NM), gastritis (GA), or peptic ulcer disease (PUD). Antimicrobial susceptibility testing was performed for amoxicillin (AML), furazolidone (FZD), metronidazole (MTZ), clarithromycin (CLA), tetracycline (TET), and levofloxacin (LEV). CYP2C19 genotyping was conducted via PCR.</div></div><div><h3>Results</h3><div>The annual number of cases increased from 13 in 2019 to 75 in 2024. Abdominal pain (89.4%) and loss of appetite (74.9%) were the most common symptoms. Endoscopic findings were primarily GA (57.0%). Resistance to FZD and TET was undetected (0%), and AML resistance was low (1.45%). High resistance rates were observed for MTZ (75.85%), CLA (75.36%), and LEV (22.22%). Dual MTZ+CLA resistance reached 61.35%, with the highest rate (18.1%) among 13-y-olds. Triple resistance (MTZ+CLA+LEV) was 16.43%. Both single and multidrug resistance increased significantly over time (<em>P</em> < 0.05). CYP2C19 genotyping revealed extensive metabolizers (EM, *1/*1) in 48.33%, intermediate metabolizers (IM, *1/*2+*1/*3) in 45.00%, and poor metabolizers (PM, *2/*2+*2/*3) in 6.67%.</div></div><div><h3>Conclusions</h3><div>The high resistance rates to MTZ and CLA, coupled with the CYP2C19 EM phenotype, may contribute to the failure of initial empirical <em>H. pylori</em> eradication in children from Henan, China. Therefore, for retreatment, it is recommended to tailor an individualized regimen based on antimicrobial susceptibility testing and CYP2C19 genotyping results.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 6-13"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470981","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: 2025-12-12DOI: 10.1016/j.jgar.2025.12.005
Tuelo Mogashoa , Justice T. Ngom , Johannes Loubser , Kedumetse Seru , Tuduetso Molefi , One Stephen , Rosemary M. Musonda , Simani Gaseitsiwe , Robin M. Warren , Anzaan Dippenaar , Elizabeth M. Streicher , Sikhulile Moyo
Background
Undetected rifampicin resistance is a threat to global tuberculosis (TB) control efforts by delaying effective treatment. In different studies, non-canonical rpoB mutations outside the rifampicin resistance-determining region have been reported at varying prevalences by country. Here, we report cases of rifampicin resistance in Botswana that were missed by the routine molecular diagnostic assays.
Methods
Individuals were tested under routine programme conditions, in accordance with national guidelines, at four designated drug-resistant TB clinics from 2017 to 2022. Initial testing at the facilities included GeneXpert MTB/RIF ultra and later phenotypic drug susceptibility testing (pDST), as well as the Hain MTBDRsl line probe assay, at the National Tuberculosis Reference Laboratory. A total of nine isolates were subsequently sequenced on the Illumina NextSeq 2000 instrument.
Results
At the point of care, routine molecular tests classified all nine individuals as susceptible to rifampicin. Subsequent culture and phenotypic drug susceptibility testing confirmed rifampicin resistance. Whole-genome sequencing identified non-canonical rpoB mutations outside the rifampicin resistance-determining region I49F and V170F, which are associated with low-level rifampicin resistance. Of the nine isolates sequenced, 4 (44%) harboured the rpoB V170F mutation, while 5 (56%) harboured the rpoB I491F mutation.
Conclusions
These results highlight a diagnostic gap within the current algorithms and show the value of sequencing-based approaches for accurately detecting drug resistance. Incorporating sequencing into routine clinical practice could help guide the selection of TB treatment and improve treatment outcomes in patients who do not respond to first-line therapy.
{"title":"Undetected rifampicin-resistant tuberculosis associated with rpoB I491F and V170F mutations in Botswana: Diagnostic implications","authors":"Tuelo Mogashoa , Justice T. Ngom , Johannes Loubser , Kedumetse Seru , Tuduetso Molefi , One Stephen , Rosemary M. Musonda , Simani Gaseitsiwe , Robin M. Warren , Anzaan Dippenaar , Elizabeth M. Streicher , Sikhulile Moyo","doi":"10.1016/j.jgar.2025.12.005","DOIUrl":"10.1016/j.jgar.2025.12.005","url":null,"abstract":"<div><h3>Background</h3><div>Undetected rifampicin resistance is a threat to global tuberculosis (TB) control efforts by delaying effective treatment. In different studies, non-canonical <em>rpoB</em> mutations outside the rifampicin resistance-determining region have been reported at varying prevalences by country. Here, we report cases of rifampicin resistance in Botswana that were missed by the routine molecular diagnostic assays.</div></div><div><h3>Methods</h3><div>Individuals were tested under routine programme conditions, in accordance with national guidelines, at four designated drug-resistant TB clinics from 2017 to 2022. Initial testing at the facilities included GeneXpert MTB/RIF ultra and later phenotypic drug susceptibility testing (pDST), as well as the Hain MTBDR<em>sl</em> line probe assay, at the National Tuberculosis Reference Laboratory. A total of nine isolates were subsequently sequenced on the Illumina NextSeq 2000 instrument.</div></div><div><h3>Results</h3><div>At the point of care, routine molecular tests classified all nine individuals as susceptible to rifampicin. Subsequent culture and phenotypic drug susceptibility testing confirmed rifampicin resistance. Whole-genome sequencing identified non-canonical <em>rpoB</em> mutations outside the rifampicin resistance-determining region I49F and V170F, which are associated with low-level rifampicin resistance. Of the nine isolates sequenced, 4 (44%) harboured the <em>rpoB</em> V170F mutation, while 5 (56%) harboured the <em>rpoB</em> I491F mutation.</div></div><div><h3>Conclusions</h3><div>These results highlight a diagnostic gap within the current algorithms and show the value of sequencing-based approaches for accurately detecting drug resistance. Incorporating sequencing into routine clinical practice could help guide the selection of TB treatment and improve treatment outcomes in patients who do not respond to first-line therapy.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 171-174"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145756899","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: 2025-11-15DOI: 10.1016/j.jgar.2025.11.004
Eunice Rui Ning Wong , Nicole Tham , Si Hui Low , Jun Cong Goh , Haresh Singaraju , Sky Wei Chee Koh
Objectives
Despite recent developments in national urinary tract infection (UTI) guidelines, primary care physicians have shown limited uptake. This study aims to evaluate the effectiveness of two antimicrobial stewardship interventions in improving antibiotic appropriateness for UTIs in primary care.
Methods
A quasi-experimental study was conducted from March to December 2024 across seven public primary care clinics in Singapore. The study evaluated two interventions: (1) an educational seminar conducted for all clinics, and (2) Epic preference list customization of prescription order sets in one intervention clinic. Segmented regression analysis was used to assess overall changes in antibiotic appropriateness after educational seminar, while difference-in-differences analysis evaluated the specific impacts of preference list customization.
Results
2874 female patients with uncomplicated UTIs (median 59 years) were seen by 301 primary care physicians, with a mean 11.8 years (SD = 9.5) of clinical experience. Educational seminar led to a significant increase in appropriateness rates (66.2% vs. 61.3%, P = 0.036) and reduction in wrong antibiotic selection (10.6% to 7.3%, P = 0.018) across all clinics. Epic preference list customization demonstrated significantly higher appropriateness rates (85.9% vs. 65.5%, P < 0.001) and lower rates of inappropriate antibiotic frequency (9.8% vs. 18.0%, P = 0.01) and duration (0% vs. 9.7%, P < 0.001) in the intervention clinic. There were no significant continued improvement in antibiotic appropriateness demonstrated after the educational seminar or preference list customization.
Conclusion
While preference list customization may be beneficial for maintaining antibiotic appropriateness, multifaceted approaches tailored to site-specific needs are necessary for continued improvements in antibiotic stewardship.
导读：尽管最近国家尿路感染（UTI）指南的发展，初级保健医生已经显示有限的吸收。本研究旨在评估两种抗菌药物管理干预措施在改善初级保健中尿路感染的抗生素适宜性方面的有效性。方法：2024年3月至12月，在新加坡7家公立初级保健诊所进行了一项准实验研究。本研究评估了两种干预措施：(1)在所有诊所开展教育研讨会，(2)在一个干预诊所定制Epic偏好列表处方单集。采用分段回归分析评估教育研讨会后抗生素适宜性的总体变化，而差异中差异分析评估偏好列表定制的具体影响。结果：301名初级保健医生共观察了2874名女性无并发症尿路感染患者（中位年龄59岁），平均临床经验为11.8年（SD 9.5）。教育研讨会显著提高了所有诊所的合适率（66.2%对61.3%,p=0.036），减少了错误的抗生素选择（10.6%对7.3%,p=0.018）。Epic偏好列表定制显示出更高的适宜率（85.9% vs 65.5%）。结论：尽管偏好列表定制可能有利于维持抗生素适宜性，但针对特定地点需求的多方面方法对于持久改善抗生素管理是必要的。
{"title":"Effectiveness of educational seminar and customized prescription order sets on antibiotic appropriateness for urinary tract infections in primary care","authors":"Eunice Rui Ning Wong , Nicole Tham , Si Hui Low , Jun Cong Goh , Haresh Singaraju , Sky Wei Chee Koh","doi":"10.1016/j.jgar.2025.11.004","DOIUrl":"10.1016/j.jgar.2025.11.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite recent developments in national urinary tract infection (UTI) guidelines, primary care physicians have shown limited uptake. This study aims to evaluate the effectiveness of two antimicrobial stewardship interventions in improving antibiotic appropriateness for UTIs in primary care.</div></div><div><h3>Methods</h3><div>A quasi-experimental study was conducted from March to December 2024 across seven public primary care clinics in Singapore. The study evaluated two interventions: (1) an educational seminar conducted for all clinics, and (2) Epic preference list customization of prescription order sets in one intervention clinic. Segmented regression analysis was used to assess overall changes in antibiotic appropriateness after educational seminar, while difference-in-differences analysis evaluated the specific impacts of preference list customization.</div></div><div><h3>Results</h3><div>2874 female patients with uncomplicated UTIs (median 59 years) were seen by 301 primary care physicians, with a mean 11.8 years (SD = 9.5) of clinical experience. Educational seminar led to a significant increase in appropriateness rates (66.2% vs. 61.3%, <em>P</em> = 0.036) and reduction in wrong antibiotic selection (10.6% to 7.3%, <em>P</em> = 0.018) across all clinics. Epic preference list customization demonstrated significantly higher appropriateness rates (85.9% vs. 65.5%, <em>P</em> < 0.001) and lower rates of inappropriate antibiotic frequency (9.8% vs. 18.0%, <em>P</em> = 0.01) and duration (0% vs. 9.7%, <em>P</em> < 0.001) in the intervention clinic. There were no significant continued improvement in antibiotic appropriateness demonstrated after the educational seminar or preference list customization.</div></div><div><h3>Conclusion</h3><div>While preference list customization may be beneficial for maintaining antibiotic appropriateness, multifaceted approaches tailored to site-specific needs are necessary for continued improvements in antibiotic stewardship.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 75-78"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540815","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.2025.11.019
Zhiqiang Zhu , Xiaofei Zhao , Zhaokun Fan , Ying Fu , Xi Li , Meizhen Ye
Objective
Raoultella ornithinolytica, a species within Enterobacteriaceae, is rarely multidrug-resistant. Here, we report a carbapenem-resistant R. ornithinolytica carrying blaOXA-181 and elucidate its genomic characteristics for the first time in China.
Methods
Antimicrobial susceptibility testing and hybrid whole-genome sequencing were conducted on the R. ornithinolytica strain CRRAO31010. Comprehensive in silico analyses of virulence determinants, resistance genes, and their genetic contexts were performed. Conjugation experiments were conducted with Escherichia coli J53 as the recipient to assess the transferability of blaOXA-181. In addition, we combined our isolate with 56 R. ornithinolytica strains bearing the blaOXA-181 gene retrieved from the NCBI database for phylogenetic analysis.
Results
R. ornithinolytica strain CRRAO31010 is a carbapenem-resistant strain characterized by its production of the OXA-181 enzyme, which confers resistance to multiple antibiotics. WGS revealed 22 antimicrobial resistance genes in CRRAO31010, including blaOXA-181 carried on a ColKP3-IncX3 hybrid plasmid. This plasmid was conjugated into E. coli J53 with a conjugation frequency of approximately 2.5 × 10−6 per donor cell. Phylogenetic analysis revealed that the earliest R. ornithinolytica strain carrying the blaOXA-181 gene was detected in the United Kingdom in 2019. The United States had the highest number of OXA-181-carrying R. ornithinolytica strains. Notably, IncX3-type plasmids had the highest prevalence (96.49%, 55/57) among these isolates.
Conclusions
We report the first carbapenem-resistant R. ornithinolytica strain harbouring the blaOXA-181 gene on a ColKP3-IncX3 hybrid plasmid from China. Given the high conjugative potential of IncX3 plasmids, vigilance is required to monitor the dissemination of such resistance determinants within R. ornithinolytica.
{"title":"Genomic and phylogenetic analysis of a carbapenem-resistant Raoultella ornithinolytica clinical isolate carrying blaOXA-181 from China","authors":"Zhiqiang Zhu , Xiaofei Zhao , Zhaokun Fan , Ying Fu , Xi Li , Meizhen Ye","doi":"10.1016/j.jgar.2025.11.019","DOIUrl":"10.1016/j.jgar.2025.11.019","url":null,"abstract":"<div><h3>Objective</h3><div><em>Raoultella ornithinolytica</em>, a species within <em>Enterobacteriaceae</em>, is rarely multidrug-resistant. Here, we report a carbapenem-resistant <em>R. ornithinolytica</em> carrying <em>bla</em><sub>OXA-181</sub> and elucidate its genomic characteristics for the first time in China.</div></div><div><h3>Methods</h3><div>Antimicrobial susceptibility testing and hybrid whole-genome sequencing were conducted on the <em>R. ornithinolytica</em> strain CRRAO31010. Comprehensive in silico analyses of virulence determinants, resistance genes, and their genetic contexts were performed. Conjugation experiments were conducted with <em>Escherichia coli</em> J53 as the recipient to assess the transferability of <em>bla</em><sub>OXA-181</sub>. In addition, we combined our isolate with 56 <em>R. ornithinolytica</em> strains bearing the <em>bla</em><sub>OXA-181</sub> gene retrieved from the NCBI database for phylogenetic analysis.</div></div><div><h3>Results</h3><div><em>R. ornithinolytica</em> strain CRRAO31010 is a carbapenem-resistant strain characterized by its production of the OXA-181 enzyme, which confers resistance to multiple antibiotics. WGS revealed 22 antimicrobial resistance genes in CRRAO31010, including <em>bla</em><sub>OXA-181</sub> carried on a ColKP3-IncX3 hybrid plasmid. This plasmid was conjugated into <em>E. coli</em> J53 with a conjugation frequency of approximately 2.5 × 10<sup>−6</sup> per donor cell. Phylogenetic analysis revealed that the earliest <em>R. ornithinolytica</em> strain carrying the <em>bla</em><sub>OXA-181</sub> gene was detected in the United Kingdom in 2019. The United States had the highest number of OXA-181-carrying <em>R. ornithinolytica strains</em>. Notably, IncX3-type plasmids had the highest prevalence (96.49%, 55/57) among these isolates.</div></div><div><h3>Conclusions</h3><div>We report the first carbapenem-resistant <em>R. ornithinolytica</em> strain harbouring the <em>bla</em><sub>OXA-181</sub> gene on a ColKP3-IncX3 hybrid plasmid from China. Given the high conjugative potential of IncX3 plasmids, vigilance is required to monitor the dissemination of such resistance determinants within <em>R. ornithinolytica</em>.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 128-131"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668726","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: 2025-12-16DOI: 10.1016/j.jgar.2025.12.006
Maiko Kirikae , Satomi Takei , Thi Thi Htoon , Pan Ei Soe , Nang Sarm Hom , San Yu Maw , May Yee Aung , Shino Hosoya , Swe Setk , Htay Htay Tin , Yuki Uehara , Teruo Kirikae , Tatsuya Tada
Objectives
Tigecycline is one of the last-resort antibiotics for treating serious infections caused by multidrug-resistant pathogens. This is the first report of clinical isolates of tigecycline-resistant Escherichia coli harbouring tet(X4) in Myanmar.
Methods
Two E. coli isolates were obtained from two patients at two hospitals in Myanmar from November 2023 to May 2024. They were identified using MALDI-TOF MS, and minimum inhibitory concentrations (MICs) were determined using the broth microdilution method. Genomic DNA was extracted and sequenced using next generation sequencing. Drug resistance factors were determined, and the genetic environments surrounding tet(X4) and blaNDM-5 were analysed. Conjugation rates of plasmids harbouring tet(X4) and blaNDM-5 were calculated.
Results
One strain, TGH62, was resistant to tigecycline (MIC 8 µg/mL) and meropenem (MIC 128 µg/mL), whereas the other, YGH433, was resistant to tigecycline (MIC 4 µg/mL). Whole-genome sequencing revealed that both strains harboured tet(X4) on plasmids and TGH62 also harboured blaNDM-5 on a plasmid. The plasmids carrying tet(X4) in TGH62 and YGH433 belonged to the IncI and IncFII incompatibility groups, respectively. The plasmid carrying blaNDM-5 belonged to the IncFIA incompatibility group. The conjugation efficiencies of the plasmids harbouring tet(X4) in YGH433 and blaNDM-5 in TGH62 were relatively high, whereas that harbouring tet(X4) in TGH62 was low.
Conclusions
Tigecycline-resistant Enterobacteriaceae harbouring tet(X4) may spread in hospitals in Myanmar. Further studies are needed to detect tet(X4) conferring tigecycline resistance in hospitals as well as environmental settings in Myanmar.
{"title":"Detection of clinical isolates of tigecycline-resistant Escherichia coli harbouring tet(X4) in Myanmar","authors":"Maiko Kirikae , Satomi Takei , Thi Thi Htoon , Pan Ei Soe , Nang Sarm Hom , San Yu Maw , May Yee Aung , Shino Hosoya , Swe Setk , Htay Htay Tin , Yuki Uehara , Teruo Kirikae , Tatsuya Tada","doi":"10.1016/j.jgar.2025.12.006","DOIUrl":"10.1016/j.jgar.2025.12.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Tigecycline is one of the last-resort antibiotics for treating serious infections caused by multidrug-resistant pathogens. This is the first report of clinical isolates of tigecycline-resistant <em>Escherichia coli</em> harbouring <em>tet</em>(X4) in Myanmar.</div></div><div><h3>Methods</h3><div>Two <em>E. coli</em> isolates were obtained from two patients at two hospitals in Myanmar from November 2023 to May 2024. They were identified using MALDI-TOF MS, and minimum inhibitory concentrations (MICs) were determined using the broth microdilution method. Genomic DNA was extracted and sequenced using next generation sequencing. Drug resistance factors were determined, and the genetic environments surrounding <em>tet</em>(X4) and <em>bla</em><sub>NDM-5</sub> were analysed. Conjugation rates of plasmids harbouring <em>tet</em>(X4) and <em>bla</em><sub>NDM-5</sub> were calculated.</div></div><div><h3>Results</h3><div>One strain, TGH62, was resistant to tigecycline (MIC 8 µg/mL) and meropenem (MIC 128 µg/mL), whereas the other, YGH433, was resistant to tigecycline (MIC 4 µg/mL). Whole-genome sequencing revealed that both strains harboured <em>tet</em>(X4) on plasmids and TGH62 also harboured <em>bla</em><sub>NDM-5</sub> on a plasmid. The plasmids carrying <em>tet</em>(X4) in TGH62 and YGH433 belonged to the IncI and IncFII incompatibility groups, respectively. The plasmid carrying <em>bla</em><sub>NDM-5</sub> belonged to the IncFIA incompatibility group. The conjugation efficiencies of the plasmids harbouring <em>tet</em>(X4) in YGH433 and <em>bla</em><sub>NDM-5</sub> in TGH62 were relatively high, whereas that harbouring <em>tet</em>(X4) in TGH62 was low.</div></div><div><h3>Conclusions</h3><div>Tigecycline-resistant <em>Enterobacteriaceae</em> harbouring <em>tet</em>(X4) may spread in hospitals in Myanmar. Further studies are needed to detect <em>tet</em>(X4) conferring tigecycline resistance in hospitals as well as environmental settings in Myanmar.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 235-240"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781088","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: 2026-01-07DOI: 10.1016/j.jgar.2025.12.016
Dapeng Fan, Hao Li, Xuechai Shang, Miaofen Yang, Huanyu Li, Yongning Yue, Long Cai
Objective
To evaluate the diagnostic performance of the InnowaveDx MTB/RIF/INH assay for the simultaneous detection of Mycobacterium tuberculosis and resistance to rifampicin and isoniazid.
Methods
We evaluated the performance of the InnowaveDx MTB/RIF/INH (InnowaveDx) assay in diagnosing pulmonary tuberculosis and detecting rifampicin and isoniazid resistance at the Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine.
Results
Using the clinical final diagnosis as the standard, the sensitivity of InnowaveDx was 68.0%, which was higher than that of acid-fast bacilli smear, MGIT culture, and Xpert (P < .001). The specificity was 97.1%, which was higher than acid-fast bacilli smear (P < .001). The agreement between InnowaveDx and MGIT phenotypic drug sensitivity, as well as Xpert, for detecting rifampicin resistance, had kappa values of 0.783 and 0.940, respectively. The agreement between InnowaveDx and MGIT phenotypic drug sensitivity, as well as multicolor melting curve analysis, for detecting isoniazid resistance, had kappa values of 0.915 and 1. The discrepancies in rifampicin- and isoniazid-resistance detection were observed in 11 and 4 cases, respectively.
Conclusions
The InnowaveDx MTB/RIF/INH assay demonstrates good performance in detecting M. tuberculosis as well as rifampicin and isoniazid resistance. The discrepancies in rifampicin-resistance results and phenotypic resistance are mainly the result of borderline resistance mutations.
{"title":"Evaluating the performance of the InnowaveDx MTB/RIF/INH for simultaneous detection of Mycobacterium tuberculosis and resistance to rifampicin and isoniazid","authors":"Dapeng Fan, Hao Li, Xuechai Shang, Miaofen Yang, Huanyu Li, Yongning Yue, Long Cai","doi":"10.1016/j.jgar.2025.12.016","DOIUrl":"10.1016/j.jgar.2025.12.016","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the diagnostic performance of the InnowaveDx MTB/RIF/INH assay for the simultaneous detection of Mycobacterium tuberculosis and resistance to rifampicin and isoniazid.</div></div><div><h3>Methods</h3><div>We evaluated the performance of the InnowaveDx MTB/RIF/INH (InnowaveDx) assay in diagnosing pulmonary tuberculosis and detecting rifampicin and isoniazid resistance at the Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine.</div></div><div><h3>Results</h3><div>Using the clinical final diagnosis as the standard, the sensitivity of InnowaveDx was 68.0%, which was higher than that of acid-fast bacilli smear, MGIT culture, and Xpert (<em>P</em> < .001). The specificity was 97.1%, which was higher than acid-fast bacilli smear (<em>P</em> < .001). The agreement between InnowaveDx and MGIT phenotypic drug sensitivity, as well as Xpert, for detecting rifampicin resistance, had <em>kappa</em> values of 0.783 and 0.940, respectively. The agreement between InnowaveDx and MGIT phenotypic drug sensitivity, as well as multicolor melting curve analysis, for detecting isoniazid resistance, had <em>kappa</em> values of 0.915 and 1. The discrepancies in rifampicin- and isoniazid-resistance detection were observed in 11 and 4 cases, respectively.</div></div><div><h3>Conclusions</h3><div>The InnowaveDx MTB/RIF/INH assay demonstrates good performance in detecting <em>M. tuberculosis</em> as well as rifampicin and isoniazid resistance. The discrepancies in rifampicin-resistance results and phenotypic resistance are mainly the result of borderline resistance mutations.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 246-253"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944586","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: 2025-11-15DOI: 10.1016/j.jgar.2025.11.008
Wei Kong , Qinghuan Zhang , Limei Zhang , Jing Yang , Xiaobin Li , Yanyan Liao
Objective
The methicillin-resistant Staphylococcus aureus (MRSA) sequence type (ST) 45 is a significant global lineage of MRSA, known for its vast strain diversity and substantial clinical impact. This study aimed to characterize the genomic characteristics and diversity of the ST45-SCCmec Vc-t1081 MRSA strains.
Methods
MRSA strain SA0907 was isolated from the skin exudate of a patient with severe drug eruption in China. The complete genome of MSRA strain SA0907 was sequenced using both Illumina (Novaseq 6000) and PacBio (Sequel II) platforms, followed by hybrid assembly of the sequences. The identification of mobile genetic elements and antibiotic resistance genes was accomplished through bioinformatics tools.
Results
The SCCmec type Vc in SA0907 was comprised of the class C2 mec gene complex (IS431-mecA-ΔmecR1-IS431) and type 5 ccr gene complex (ccrC1 allele 2 and ccrC1 allele 8). Notably, the MRSA strain SA0907 was the first complete genome data for the ST45-SCCmec Vc-t1081 MRSA in Mainland of China. The disinfectant resistance genes qacA/qacR were chromosomally located within a variable region containing Tn552 and Tn4001 in MRSA strain SA0907. The 2.46-kb plasmid pSA0907-2 from MRSA strain SA0907 harbored erm(C), which conferred MLSB (macrolides-lincosamides-streptogramins B) resistance. Small plasmids similar to the 2.46-kb plasmid pSA0907-2 were prevalent across the Staphylococcus genus, particularly in S. aureus.
Conclusion
MRSA strain SA0907 represents the first complete genome report of a qacA-harboring ST45-SCCmec Vc-t1081 MRSA in Mainland of China. One 2.46-kb erm(C)-harboring plasmid pSA0907-2 carried by the MRSA strain SA0907 was widely present in S. aureus and other staphylococci.
{"title":"Whole-genome analysis of qacA-harboring ST45-SCCmec Vc-t1081 MRSA from skin exudate in a Chinese patient with severe drug eruption","authors":"Wei Kong , Qinghuan Zhang , Limei Zhang , Jing Yang , Xiaobin Li , Yanyan Liao","doi":"10.1016/j.jgar.2025.11.008","DOIUrl":"10.1016/j.jgar.2025.11.008","url":null,"abstract":"<div><h3>Objective</h3><div>The methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) sequence type (ST) 45 is a significant global lineage of MRSA, known for its vast strain diversity and substantial clinical impact. This study aimed to characterize the genomic characteristics and diversity of the ST45-SCC<em>mec</em> Vc-t1081 MRSA strains.</div></div><div><h3>Methods</h3><div>MRSA strain SA0907 was isolated from the skin exudate of a patient with severe drug eruption in China. The complete genome of MSRA strain SA0907 was sequenced using both Illumina (Novaseq 6000) and PacBio (Sequel II) platforms, followed by hybrid assembly of the sequences. The identification of mobile genetic elements and antibiotic resistance genes was accomplished through bioinformatics tools.</div></div><div><h3>Results</h3><div>The SCC<em>mec</em> type Vc in SA0907 was comprised of the class C2 <em>mec</em> gene complex (IS<em>431</em>-<em>mecA</em>-Δ<em>mecR1</em>-IS<em>431</em>) and type 5 <em>ccr</em> gene complex (<em>ccrC1</em> allele 2 and <em>ccrC1</em> allele 8). Notably, the MRSA strain SA0907 was the first complete genome data for the ST45-SCC<em>me</em>c Vc-t1081 MRSA in Mainland of China. The disinfectant resistance genes <em>qacA</em>/<em>qacR</em> were chromosomally located within a variable region containing Tn<em>552</em> and Tn<em>4001</em> in MRSA strain SA0907. The 2.46-kb plasmid pSA0907-2 from MRSA strain SA0907 harbored <em>erm(C)</em>, which conferred MLS<sub>B</sub> (macrolides-lincosamides-streptogramins B) resistance. Small plasmids similar to the 2.46-kb plasmid pSA0907-2 were prevalent across the <em>Staphylococcus</em> genus, particularly in <em>S. aureus</em>.</div></div><div><h3>Conclusion</h3><div>MRSA strain SA0907 represents the first complete genome report of a <em>qacA</em>-harboring ST45-SCC<em>mec</em> Vc-t1081 MRSA in Mainland of China. One 2.46-kb <em>erm(C)</em>-harboring plasmid pSA0907-2 carried by the MRSA strain SA0907 was widely present in <em>S. aureus</em> and other staphylococci.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 71-74"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540985","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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