Pub 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":"2025-11-17","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}
Community-acquired pneumonia (CAP) remains a major global health concern, particularly in regions with rising antimicrobial resistance (AMR). In Lebanon, increasing resistance among respiratory pathogens complicates management, limiting treatment options and worsening clinical and economic outcomes. This expert panel review assessed recent national AMR data to adapt CAP treatment recommendations to the Lebanese context. The 2019 ATS/IDSA guidelines and their 2025 update were reviewed; while most recommendations were retained, empiric antibiotic choices were adjusted for key pathogens based on local resistance patterns. The proposed management algorithm stratifies patients by disease severity, care setting, and AMR risk, integrating pathogen-specific risk factors into clinical decisions. By contextualizing international guidance to local epidemiology and healthcare infrastructure, these recommendations aim to optimize targeted therapy, support antimicrobial stewardship, and preserve antibiotic efficacy in Lebanon’s evolving resistance landscape.
{"title":"Adapting international evidence-based guidelines to local challenges: A Lebanese perspective on the latest American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) community-acquired pneumonia antibacterial therapy recommendations","authors":"Rana Attieh , Joe Nahal , Rola Husni , Jacques E. Mokhbat , Jamil Barhoun , Joumana Kmeid , Mona Youssef , Zahi Helou , Wael Zorkot , Nassab Fakhreddine , Fatima Baalbaki , Nazih Bizri , Hanine Mansour , Dania Abdallah , Rima Moghnieh","doi":"10.1016/j.jgar.2025.11.005","DOIUrl":"10.1016/j.jgar.2025.11.005","url":null,"abstract":"<div><div>Community-acquired pneumonia (CAP) remains a major global health concern, particularly in regions with rising antimicrobial resistance (AMR). In Lebanon, increasing resistance among respiratory pathogens complicates management, limiting treatment options and worsening clinical and economic outcomes. This expert panel review assessed recent national AMR data to adapt CAP treatment recommendations to the Lebanese context. The 2019 ATS/IDSA guidelines and their 2025 update were reviewed; while most recommendations were retained, empiric antibiotic choices were adjusted for key pathogens based on local resistance patterns. The proposed management algorithm stratifies patients by disease severity, care setting, and AMR risk, integrating pathogen-specific risk factors into clinical decisions. By contextualizing international guidance to local epidemiology and healthcare infrastructure, these recommendations aim to optimize targeted therapy, support antimicrobial stewardship, and preserve antibiotic efficacy in Lebanon’s evolving resistance landscape.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 98-108"},"PeriodicalIF":3.2,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557031","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 : 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":"2025-11-15","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 : 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":"2025-11-15","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 : 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":"2025-11-15","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}
Pub Date : 2025-11-10DOI: 10.1016/j.jgar.2025.11.003
A.C. Ka’e , F. Bassani , O. El Khalili , A. Bezenchek , F. Carli , A. Pupo , E. Gentilini Cacciola , L. Pezzati , L. Duca , I. Vicenti , W. Gennari , F. Lombardi , A. Shallvari , F. Saladini , V. Micheli , A. Cozzi-Lepri , A. Lai , M.M. Santoro , S. Rusconi , the ARCA Study Group
Objective
We evaluated the prevalence of HIV-1 drug resistance in newly diagnosed individuals from 2017 to 2023, in Italy.
Methods
Transmitted drug resistance (TDR) was evaluated by using the HIVdb algorithm (https://hivdb.stanford.edu/), through two different approaches: (1) by considering the complete list of mutations included for the genotypic susceptibility score and (2) by considering only major resistant mutations. Logistic regression analysis was used to estimate the association of TDR with the calendar year.
Results
We analysed 1188 drug-naive individuals diagnosed in Italy between 2017 and 2023 enrolled in the Antiviral Response Cohort Analysis database. Most of them (∼75 %) were males; their median (IQR) age was 40 (30–50) years. Non-B subtypes were found in 43.9 % of participants and significantly increased over time (from 44.2 % in 2017 to 54.8 % in 2023, P = 0.008). TDR prevalence was 29 %, driven by non-nucleoside reverse transcriptase inhibitor resistance (19.4 %). Rates of nucleoside reverse transcriptase inhibitors, protease inhibitors, and integrase strand transfer inhibitors resistance were 4.7 %, 4.4 %, and 5.1 %, respectively, with no significant temporal trends. When only major resistant mutations were considered, TDR prevalence was definitively lower (15.8 %), primarily driven by non-nucleoside reverse transcriptase inhibitor mutations (11.8 %). Rates of resistance for major nucleoside reverse transcriptase inhibitors, protease inhibitors, and integrase strand transfer inhibitors were 4.6 %, 1.7 % and 0.7 %, respectively. Resistance to two or more drug classes was rare (1.9 %). No association of major TDR within the calendar year was found, except for 2023 (AOR: 2.33 [1.14–4.74], P = 0.019).
Conclusions
Over the period 2017–2023, the HIV-1 TDR appeared generally stable in Italy. However, the increased prevalence of major TDR in 2023 confirms the importance of continuous TDR surveillance in newly diagnosed individuals to inform clinical practice.
{"title":"Evaluation of HIV-1 drug resistance in newly diagnosed individuals in Italy over the period 2017–2023","authors":"A.C. Ka’e , F. Bassani , O. El Khalili , A. Bezenchek , F. Carli , A. Pupo , E. Gentilini Cacciola , L. Pezzati , L. Duca , I. Vicenti , W. Gennari , F. Lombardi , A. Shallvari , F. Saladini , V. Micheli , A. Cozzi-Lepri , A. Lai , M.M. Santoro , S. Rusconi , the ARCA Study Group","doi":"10.1016/j.jgar.2025.11.003","DOIUrl":"10.1016/j.jgar.2025.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>We evaluated the prevalence of HIV-1 drug resistance in newly diagnosed individuals from 2017 to 2023, in Italy.</div></div><div><h3>Methods</h3><div>Transmitted drug resistance (TDR) was evaluated by using the HIVdb algorithm (<span><span>https://hivdb.stanford.edu/</span><svg><path></path></svg></span>), through two different approaches: (1) by considering the complete list of mutations included for the genotypic susceptibility score and (2) by considering only major resistant mutations. Logistic regression analysis was used to estimate the association of TDR with the calendar year.</div></div><div><h3>Results</h3><div>We analysed 1188 drug-naive individuals diagnosed in Italy between 2017 and 2023 enrolled in the Antiviral Response Cohort Analysis database. Most of them (∼75 %) were males; their median (IQR) age was 40 (30–50) years. Non-B subtypes were found in 43.9 % of participants and significantly increased over time (from 44.2 % in 2017 to 54.8 % in 2023, <em>P</em> = 0.008). TDR prevalence was 29 %, driven by non-nucleoside reverse transcriptase inhibitor resistance (19.4 %). Rates of nucleoside reverse transcriptase inhibitors, protease inhibitors, and integrase strand transfer inhibitors resistance were 4.7 %, 4.4 %, and 5.1 %, respectively, with no significant temporal trends. When only major resistant mutations were considered, TDR prevalence was definitively lower (15.8 %), primarily driven by non-nucleoside reverse transcriptase inhibitor mutations (11.8 %). Rates of resistance for major nucleoside reverse transcriptase inhibitors, protease inhibitors, and integrase strand transfer inhibitors were 4.6 %, 1.7 % and 0.7 %, respectively. Resistance to two or more drug classes was rare (1.9 %). No association of major TDR within the calendar year was found, except for 2023 (AOR: 2.33 [1.14–4.74], <em>P</em> = 0.019).</div></div><div><h3>Conclusions</h3><div>Over the period 2017–2023, the HIV-1 TDR appeared generally stable in Italy. However, the increased prevalence of major TDR in 2023 confirms the importance of continuous TDR surveillance in newly diagnosed individuals to inform clinical practice.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 38-45"},"PeriodicalIF":3.2,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504984","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 : 2025-11-07DOI: 10.1016/j.jgar.2025.11.001
Sheng-Bin Fan , Hung-Ling Huang , Hung-Pin Tu , Benjamin Sobkowiak , Meng-Hsuan Cheng , Wei-Chang Huang , Yi-Wen Huang , Shang-Yi Lin , Inn-Wen Chong , Po-Liang Lu
Objectives
Mycobacterium kansasii (M. kansasii) pulmonary disease is an emerging global health concern, and the pathogen's resistance to antimicrobial agents is challenging. Understanding the epidemiology of drug resistance rates and the associated risk factors is useful for guiding antimicrobial agent selection for M. kansasii treatment.
Methods
This retrospective cohort study analysed 361 pathogenic M. kansasii isolates collected from patients with M. kansasii pulmonary disease in two tertiary medical centres in Taiwan between 2011 and 2022. Antimicrobial susceptibility testing was performed using Sensititre™ SLOMYCO1 or SLOMYCO2, and MIC breakpoints were according to CLSI 2018. We applied multivariate logistic regression and Cochran–Mantel–Haenszel test to assess the factors associated with drug resistance.
Results
Most M. kansasii isolates in Taiwan remained susceptible to the first-line agents, including rifampin (92.2%) and clarithromycin (98.6%). High resistance rates were observed in ciprofloxacin (42.7%), doxycycline (56.2%), and trimethoprim/sulfamethoxazole (87.8%). The drug resistance rates of tested antibiotics for M. kansasii increased notably in 2018–2022 compared to those between 2015–2017. M. kansasii isolates from central Taiwan exhibited significantly higher resistance rates in all drugs compared to those in southern Taiwan. Pulmonary fibrocavitary lesion was an independent risk factor for resistance to rifampin and ciprofloxacin.
Conclusions
The study reveals increasing resistance to the first- and second-line agents in M. kansasii isolates across Taiwan. Resistance epidemiology differed between regions. Fibrocavitary lung lesion was significantly associated with drug resistance. These findings underscore the importance of region-specific surveillance to undergo individualized treatment strategies for M. kansasii pulmonary disease.
{"title":"The resistance trends in Mycobacterium kansasii pulmonary isolates and identification of risk factors for drug resistance in Taiwan","authors":"Sheng-Bin Fan , Hung-Ling Huang , Hung-Pin Tu , Benjamin Sobkowiak , Meng-Hsuan Cheng , Wei-Chang Huang , Yi-Wen Huang , Shang-Yi Lin , Inn-Wen Chong , Po-Liang Lu","doi":"10.1016/j.jgar.2025.11.001","DOIUrl":"10.1016/j.jgar.2025.11.001","url":null,"abstract":"<div><h3>Objectives</h3><div><em>Mycobacterium kansasii</em> (<em>M. kansasii</em>) pulmonary disease is an emerging global health concern, and the pathogen's resistance to antimicrobial agents is challenging. Understanding the epidemiology of drug resistance rates and the associated risk factors is useful for guiding antimicrobial agent selection for <em>M. kansasii</em> treatment.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analysed 361 pathogenic <em>M. kansasii</em> isolates collected from patients with <em>M. kansasii</em> pulmonary disease in two tertiary medical centres in Taiwan between 2011 and 2022. Antimicrobial susceptibility testing was performed using Sensititre™ SLOMYCO1 or SLOMYCO2, and MIC breakpoints were according to CLSI 2018. We applied multivariate logistic regression and Cochran–Mantel–Haenszel test to assess the factors associated with drug resistance.</div></div><div><h3>Results</h3><div>Most <em>M. kansasii</em> isolates in Taiwan remained susceptible to the first-line agents, including rifampin (92.2%) and clarithromycin (98.6%). High resistance rates were observed in ciprofloxacin (42.7%), doxycycline (56.2%), and trimethoprim/sulfamethoxazole (87.8%). The drug resistance rates of tested antibiotics for <em>M. kansasii</em> increased notably in 2018–2022 compared to those between 2015–2017. <em>M. kansasii</em> isolates from central Taiwan exhibited significantly higher resistance rates in all drugs compared to those in southern Taiwan. Pulmonary fibrocavitary lesion was an independent risk factor for resistance to rifampin and ciprofloxacin.</div></div><div><h3>Conclusions</h3><div>The study reveals increasing resistance to the first- and second-line agents in <em>M. kansasii</em> isolates across Taiwan. Resistance epidemiology differed between regions. Fibrocavitary lung lesion was significantly associated with drug resistance. These findings underscore the importance of region-specific surveillance to undergo individualized treatment strategies for <em>M. kansasii</em> pulmonary disease.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 49-56"},"PeriodicalIF":3.2,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482270","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 : 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":"2025-11-05","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 : 2025-10-31DOI: 10.1016/j.jgar.2025.10.012
Rabia Kanwar , Muhammad Aamir Aslam , Sajjad Ur Rahman , Muhammad Saqib
Objective
Multidrug resistance Pseudomonas aeruginosa is a global public health issue, and bacteriophages are an effective alternative therapy over antibiotics to combat antibiotic resistance. This study was designed to isolate bacteriophages and determine their antimicrobial potential against P. aeruginosa isolated from burn wounds and the environment of the burn ward.
Methods
A total of 100 random swab samples were collected from the burn ward, including 50 from the burn wounds and 50 from the environment and proceeded for further investigations at the University of Agriculture Faisalabad. P. aeruginosa was confirmed by genomic detection of OprL gene. Bacteriophages were isolated from sewage water through the agar overlay method, and their lytic spectrum was determined. Genome sequencing and analysis was performed. Phage stability and synergism between phage and antibiotics were analysed.
Results
Overall, 50 samples were positive for P. aeruginosa, in which 35 of 50 were positive from wounds of patients with burns, and 15 of 50 were positive from the hospital environment. OprL-positive strains were selected for bacteriophage isolation. Two phages, PhPa-6 and PhPa-4, with lytic spectra of 88 % and 60 %, respectively, were selected. The genome sizes of PhPa-6 and PhPa-4 were 186.978 kb and 73.3 kb, respectively. A cocktail of these phages has shown an active in vitro synergistic effect with ciprofloxacin (0.125 µg/mL).
Conclusions
A cocktail of PhPa-6 and PhPa-4 in combination with ciprofloxacin displayed significant lytic activity under in vitro conditions and a broad host range against P. aeruginosa isolates from patients with burns.
{"title":"Isolation and in vitro evaluation of bacteriophages against Pseudomonas aeruginosa isolated from burn wounds of human patients and hospital environment","authors":"Rabia Kanwar , Muhammad Aamir Aslam , Sajjad Ur Rahman , Muhammad Saqib","doi":"10.1016/j.jgar.2025.10.012","DOIUrl":"10.1016/j.jgar.2025.10.012","url":null,"abstract":"<div><h3>Objective</h3><div>Multidrug resistance <em>Pseudomonas aeruginosa</em> is a global public health issue, and bacteriophages are an effective alternative therapy over antibiotics to combat antibiotic resistance. This study was designed to isolate bacteriophages and determine their antimicrobial potential against <em>P. aeruginosa</em> isolated from burn wounds and the environment of the burn ward.</div></div><div><h3>Methods</h3><div>A total of 100 random swab samples were collected from the burn ward, including 50 from the burn wounds and 50 from the environment and proceeded for further investigations at the University of Agriculture Faisalabad. <em>P. aeruginosa</em> was confirmed by genomic detection of <em>OprL</em> gene. Bacteriophages were isolated from sewage water through the agar overlay method, and their lytic spectrum was determined. Genome sequencing and analysis was performed. Phage stability and synergism between phage and antibiotics were analysed.</div></div><div><h3>Results</h3><div>Overall, 50 samples were positive for <em>P. aeruginosa</em>, in which 35 of 50 were positive from wounds of patients with burns, and 15 of 50 were positive from the hospital environment. <em>OprL</em>-positive strains were selected for bacteriophage isolation. Two phages, PhPa-6 and PhPa-4, with lytic spectra of 88 % and 60 %, respectively, were selected. The genome sizes of PhPa-6 and PhPa-4 were 186.978 kb and 73.3 kb, respectively. A cocktail of these phages has shown an active in vitro synergistic effect with ciprofloxacin (0.125 µg/mL).</div></div><div><h3>Conclusions</h3><div>A cocktail of PhPa-6 and PhPa-4 in combination with ciprofloxacin displayed significant lytic activity under in vitro conditions and a broad host range against <em>P. aeruginosa</em> isolates from patients with burns.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 22-30"},"PeriodicalIF":3.2,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431105","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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