Antimicrobial resistance (AMR) impacts populations unequally, with high-income countries showing inequalities in infection rates, antimicrobial-resistant infection and antimicrobial exposure. This article describes the process used to propose national health inequalities targets and commitments for the 2024-2029 UK AMR National Action Plan (NAP) alongside a case study highlighting the progress made toward meeting its commitments. NAPs published in or before 2023 by the Organisation for Economic Co-operation and Development countries were searched for references to health inequalities. A modified, four-stage Delphi process was used to reach consensus on health inequalities targets and commitments for inclusion in the second UK NAP. Following the NAP publication, a progress review assessed the UK Health Security Agency’s (UKHSA) (England’s national public health institution responsible for AMR surveillance) performance against health inequalities commitments. Twenty-three NAPs met the eligibility criteria and four NAPs (17%) from Canada, New Zealand and the United Kingdom referenced health inequalities. Consensus-based commitments focused on improving reporting of health inequalities data, developing tools to identify and address inequalities, and implementing and evaluating interventions. Following the first year of the 2024-29 NAP, a gap analysis of the UKHSA surveillance data demonstrated consistent reporting of health inequalities data across routine healthcare-associated infection and AMR outputs, a health inequalities toolkit is in development and scoping reviews have commenced to inform intervention development.

There is an inadequate understanding of how antimicrobial resistance (AMR) governance initiatives have been operationalized in low- and middle income countries (LMICs). This scoping review examines peer-reviewed literature on this topic. We searched EMBASE, CAB Abstracts, Scopus, CINAHL, Web of Science, PubMed, and Hinari databases for articles on AMR governance within and across human, animal, environment, and plant health from 2000 to 2024. We screened articles for inclusion and used thematic analysis to synthesize information from included articles. We identified 50 articles, which suggest that AMR governance in LMICs is predominantly shaped by the Global Action Plan. National Action Plans are the most widely adopted AMR governance tool, but with little contextualization and uneven implementation progress. Although the One Health (OH) approach is central to AMR containment, complex coordination and power hierarchies across a diverse range of global, regional, and country-specific AMR stakeholders with distinct roles, capacities, and interests, undermine its use, and contribute to inequities in containment responses. Strengthening AMR governance in LMICs requires institutional and political commitment, just and equitable involvement of OH stakeholders, and the mainstreaming of AMR containment into existing structures to leverage existing resources, skills and institutional capacity while contextualizing responses to local needs.

This study reports on the safety profile of Loigolactobacillus coryniformis WBB05 for food industry applications and identifies glycerol-3-phosphate oxidase (GlpO) as a candidate gene associated with aerobic reuterin production. The safety of L. coryniformis WBB05 was evaluated through whole-genome sequencing, phenotypic analysis of haemolytic activity and determination of minimum inhibitory concentrations (MICs) of antibiotics. Comparative genomic analysis was performed to identify candidate genetic determinants for aerobic reuterin production. The draft genome (2.83 Mb, 179 contigs) harboured no known virulence factors, acquired antimicrobial resistance (AMR) genes or biogenic amine biosynthetic genes. Prophage analysis identified only one incomplete prophage region, and four CRISPR–Cas systems (212 spacers) were consistent with phage defence capacity. Secondary metabolite analysis revealed biosynthetic gene clusters encoding a coagulin-like bacteriocin. No β-haemolytic activity was observed. The MICs of all antibiotics tested were below the European Food Safety Authority cut-off values except for kanamycin (128 mg/L), although no acquired AMR genes were detected. Comparative genomic analysis revealed that L. coryniformis WBB05 possesses two putative copies of GlpO, a gene not detected in publicly available genomes of Limosilactobacillus reuteri, which produces reuterin only under anaerobic conditions. These findings support the use of L. coryniformis WBB05 as a safe adjunct culture for dairy applications and highlight GlpO as a candidate determinant of aerobic reuterin production. Further studies comparing GlpO-positive and GlpO-negative strains under aerobic and anaerobic conditions are warranted to confirm the role of GlpO.

Antimicrobial resistance (AMR) is a major global public health threat which disproportionately affects low- and middle-income countries. It intersects with other public health issues including climate change and its impact is compounded by existing socio-economic inequities. In the South Asian setting, persistent gender and caste-based discrimination create differences in infection susceptibility, health-seeking behaviours, accessibility and affordability to essential antibiotics, and quality health care and appropriate diagnosis by healthcare providers, resulting in disparities in healthcare access and outcomes. We report on the deliberations from a cross-disciplinary workshop held in Bengaluru, India, focusing on the Indian context of AMR and its intersections with gender, caste, and climate change—contexts that often apply to the rest of South Asia. The two-day workshop brought together healthcare professionals, public health experts, gender experts, climate experts, researchers, activists, and community members to explore institutional and community-level issues in AMR, gender, caste, and climate change. We also present a conceptual framework to understand how caste-based discrimination influences antibiotic use and AMR in India and other South Asian countries. Finally, we discuss the key recommendations highlighted by the experts to address the gender and caste blind spots in existing data collection methods, surveillance, and policy measures related to AMR.

Antimicrobials form the backbone of modern medicine and represent a foundational pillar of economic productivity. Overuse and misuse have led to a rising trend of antimicrobial resistance (AMR), depleting the efficacy of existing antimicrobials, necessitating conservation through stewardship and renewal through innovation. Poor global access exacerbates these challenges. We introduce the concept of antimicrobial effectiveness (AME) as a system in which antimicrobials are clinically and microbiologically efficacious against infectious pathogens and accessible for appropriate use. We frame AME as a global economic infrastructure, demonstrating its role as a key input to health, social, and economic outcomes and driver of positive spillovers. We investigate the balance between capacity constraints imposed by AMR and the benefits of maximizing non-discriminatory sharing of AME, exploring how a sustainable management approach comprised of infection prevention, universal access, stewardship, surveillance, and innovation can conserve AME. We explore economic mechanisms such as internalized healthcare overheads and hypothecated taxes to align contributions with benefits, ensuring that patients, hospitals, and businesses who rely on AME help to conserve it. Through identifying social value, patterns of payoffs, and downstream beneficiaries of AME, infrastructure framing provides a coherent axis to structure action, align incentives, and mobilize investment across sectors and scales.

The rise of antimicrobial resistance (AMR), driven by relentless microbial evolution, threatens the foundations of global healthcare. Rather than following the so far undeliverable promise of evermore broad-spectrum antibiotics, infectious disease treatment can follow the example of oncology, which has, over a short period, augmented a platform of commodity anti-cancer agents with precision medicines and diagnostics to combat cancer evolution on a personalised basis. It is this shift that has allowed a significant extension in survival and has created entirely new subsectors of biotech. Sophisticated thinking and concerted action have also made changes to clinical practice and pathways. Applying these principles, precision antimicrobials, guided by rapid diagnostics and used alongside commodity products, offer a way to target resistant infections more effectively. Moreover, thinking about medicines that target multi-drug resistant infections as precision agents for rare occurrences opens up precedented reimbursement frameworks that could break the economic logjam that has smothered the sector for a generation. This is not the science of the future. The foundations of precision antimicrobial approaches are already emerging, with an ecosystem of initiatives to wrap around and support their development. Among these, Pathways to Antimicrobial Clinical Efficacy, a global AMR R&D platform that funds and offers wrap-around support for the development of new diagnostics and therapeutics, provides crucial infrastructure for emerging pipelines. Precision approaches have the potential to save lives that could otherwise be lost to resistant infections, while preserving the effectiveness of existing antimicrobials for future generations. Change is starting but cannot be left in the ‘too difficult’ tray. Microbial evolution and our own actions guarantee that we will need to adopt a new approach in our antimicrobial battle, and our lessons from the COVID-19 pandemic are that we need to act in advance, not in crisis.

We aimed to comprehensively assess Stenotrophomonas maltophilia infections, examining their incidence and clinical and microbiological characteristics in a tertiary hospital between 2021 and 2023. Primary outcomes were 30-day mortality and desirability-of-outcome ranking (DOOR). S. maltophilia incidence rose from 0.38 in 2017 to 2.66 cases/1000 patient-days in 2023, correlated with carbapenem consumption (rho = 0.90, p = 0.04). The cohort included 101 patients (median age of 61 years, IQR 43–71); 63% were male patients, 91% admitted in ICU, predominantly with lower respiratory tract infections (75%). Difficult-to-treat resistance (DTR) was identified in 14% of the isolates and associated with previous trimethoprim–sulfamethoxazole (TMP–SMX) use (aOR 23.15, 95% CI 3.67–145.77). Thirty-day mortality was 25% and associated with invasive mechanical ventilation (aOR 5.80, 95% CI 1.03–32.63), while appropriate definitive therapy was protective (aOR 0.01, 95% CI <0.01–0.16). Worse DOOR outcomes were associated with levofloxacin-resistant isolates (69.3%, CI 55.9%–80.9%) and inappropriate definitive treatment (81.1%, 95% CI 68.2%–90.8%). Overall, S. maltophilia has emerged as a relevant carbapenem-resistant gram-negative bacteria, with a high frequency of DTR phenotypes associated with previous TMP–SMX exposure. Appropriate therapy and levofloxacin susceptibility were linked to better outcomes.

Antimicrobial resistance (AMR) is a serious and urgent global health challenge that is often presented as a war on “superbugs.” The implicit message is that certain pathogenic microbes should be eliminated. With a focus on AMR innovation, I explain how microbes have been relegated to an abstract notion of property that may be controlled, manipulated, and owned. In this context, the treatment of microbes merely as an exploitable resource renders redundant ecological evaluation since only anthropocentric needs matter. Drawing on insights and concepts from the humanities and social sciences, I explain what ecological equity means when microbes are recognised to have moral value, creative agency, and situated knowledge. By this view, the patent system becomes inherently unfair because it neither considers nor rewards the inventive contributions of microbes. It also does not consider the ecological impact that an invention may have. Social institutions (like patent systems) that apply to AMR innovation must shift away from the human–nonhuman divide and adopt an ecological or biocentric approach to allow both human and microbial environments to flourish. I argue that the attribution of rights to microbes not only helps to realise this end but also enables conceptual cross-pollination across law, the humanities, and social sciences and steers the “greening” of legal regimes that apply to AMR innovation.

The Vietnam National Action Plan (NAP) for antimicrobial resistance (AMR) mitigation is a guiding document in the fight against AMR, which outlines policies to slow down the AMR progression and reduce its impact. However, progress in NAP implementation has been uneven. This study implemented 10-stakeholder consultations to explore the NAP implementation through the Just Transition lens with particular focus on tensions, trade-offs, inequalities, and unintended consequences that may inhibit progress. There were 89 participants representing healthcare staff, community members, farmers, drug suppliers, meat handlers, and government agencies responsible for environmental management, sanitation, and hygiene. We used the Just Transition framework to explore perspectives and experiences of NAP implementation in Ha Noi and Nam Dinh province, Vietnam. We found limited contributions of stakeholders to NAP activities and low awareness about its impact. They lacked dedicated resources to implement NAP activities and an effective collaboration mechanism across sectors. Cross-sectoral collaboration has the potential to improve efficiency but may also introduce conflict among stakeholders. Just Transition framing highlights how greater involvement in decision-making and planning could increase visibility, buy-in, and motivation for action among different stakeholders, while making tensions explicit could help with balancing competing interests and ensuring fair distribution of limited resources.

This retrospective study analysed 14,625 isolates of the six major hospital-associated ‘ESKAPE’ pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) collected between 2002 and 2024 in a Hungarian tertiary-care centre. Antimicrobial resistance was assessed using the antibiotic resistance index (ARI), multidrug resistance (MDR) ratios, and resistance instability index (RII). A. baumannii and E. faecium showed the highest resistance burdens and instability. Age showed a significant monotonic association with resistance (Spearman r = 0.88), with peaks in infants, middle-aged women, and the elderly. Species-specific age trends varied, with a negative correlation seen in Enterobacter spp. Hierarchical clustering grouped pathogens by resistance trajectory rather than taxonomy. Pairwise resistance distances confirmed divergence between Gram-positive and Gram-negative species. Resistance to aminoglycosides and sulphonamides showed the highest year-to-year variability, as quantified by the RII, particularly in A. baumannii and E. faecium. Vector autoregressive (VAR) modelling predicted continued MDR increases in these species. A strong correlation was found between ARI and RII (Pearson r = 0.85, p = 0.032). These findings underscore the importance of integrating resistance magnitude and volatility in surveillance.

Bovine mastitis caused by Staphylococcus aureus increases antimicrobial use and may compromise milk quality, yet genomic evidence from subtropical China remains limited. This study aimed to characterise the genomic epidemiology, antimicrobial non-susceptibility and functional risk tiers of dairy-associated S. aureus in northern Fujian, China. We analysed 59 S. aureus isolates recovered from 162 bulk-tank milk samples collected from 14 farms during 2023–2024, using whole-genome sequencing, MLST/spa typing and core-genome SNP phylogenetics, together with disc diffusion susceptibility testing (CLSI M100) and annotation of resistance, virulence and plasmid replicons (CARD, VFDB and PlasmidFinder). An unsupervised multivariate workflow (principal component analysis followed by K-means clustering) integrated genomic and phenotypic features to assign functional-risk tiers. Seven MLST and eight spa types were detected, dominated by ST1-t114/t127 (40.7%) and ST9784-t189 (20.3%). Livestock-associated MRSA ST59-t437 carrying SCCmec IV and IEC-D was detected in raw milk from this region for the first time. Overall, 45.8% of isolates were non-susceptible to at least one antimicrobial, most commonly penicillin and ampicillin (28.8% each). ST9784-t189 more frequently carried lnu(A) and pLNU4-like plasmid sequences and showed higher clindamycin non-susceptibility than other lineages. PCA/K-means grouped isolates into low-, medium- and high-risk tiers (76.3%, 15.3% and 8.4%, respectively); medium/high tiers showed higher multidrug non-susceptibility and a greater enterotoxin gene burden and were more often associated with plasmid replicons including pKH1 and pAMalpha1. This single-province pilot study provides a genomic baseline for dairy-associated S. aureus in subtropical China and suggests that unsupervised multivariate grouping may support risk-aware surveillance and milk-quality assurance; larger multi-region datasets are needed to assess generalisability.

Antimicrobial resistance (AMR) is among the most urgent global health challenges of our time. However, it is also a human rights and environmental crisis deeply entwined with climate change, biodiversity loss, and pollution. Historically, AMR was framed as a public health challenge, with little consideration given to its environmental factors and human rights implications. In this article, we examine AMR through the lens of the right to a healthy environment, exploring whether a normative human rights framework could open up new avenues to seek justice and accountability for the environmental drivers of AMR. Drawing on recent developments in international law, we suggest that this newly recognized right widens the narrative of AMR, drawing attention to the role of microbial environments in the global ecosystem and compelling more holistic responses that extend beyond public health interventions to address the underlying structural inequalities and environmental drivers of AMR.

Antimicrobial resistance (AMR) is a pressing global health challenge, with sub-Saharan Africa experiencing the highest burden of AMR-related deaths. Inappropriate prescribing and rising antibiotic consumption drive AMR, while limited local data hampers antimicrobial stewardship efforts. This study analysed Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) data from Tygerberg Hospital to identify antimicrobial use trends and inform stewardship priorities. Standard Global-PPS methodology was employed at three distinct time points. All inpatients prescribed at least one antimicrobial on the day of each survey were included in the analysis. Among 3,524 hospitalized patients, 25.9% (911/3,524) received antimicrobial therapy. Overall antimicrobial use decreased significantly (p < 0.05), with the largest reduction among paediatric patients (p < 0.01). Community-acquired infections accounted for the majority of prescriptions (50.7%; 483/952) and empirical antibiotic use was high (85.3%, 872/1022). ‘Access’ antibiotics constituted 62.7% (750/1196) of prescriptions. Single-dose prescriptions for surgical prophylaxis accounted for 17.6% (15/85). This study demonstrates progress in stewardship, particularly among paediatric inpatients. Ongoing monitoring of broad-spectrum antibiotic use and adherence to single-dose surgical prophylaxis guidelines are essential priorities. Continued Global-PPS surveillance is crucial to track trends and guide future AMS interventions.

This study examines spatiotemporal patterns of tetracycline- and trimethoprim–sulfamethoxazole (TMP–SMX)–resistant Staphylococcus aureus (S. aureus) among United States (US) Veterans Health Administration (VHA) outpatients. Prevalence of tetracycline and TMP–SMX resistance in methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) was calculated for 2010–2023. MRSA cases from 2018 to 2022 were aggregated to commuting zones (CZs) in the eastern US, and CZ-specific relative risks and temporal trends were estimated using a hierarchical Bayesian Poisson model with a spatiotemporal interaction term. Results indicated that resistance in MRSA increased by 16.4% for tetracycline and 9.3% for TMP–SMX, while MSSA resistance remained stable. High-risk CZs were limited (3% for tetracycline, 4% for TMP–SMX) and distributed across the eastern US, with notable within-state variation in risk and trend. Most CZs exhibited stationary trends, although distinct patterns in the rate and timing of changes in resistance were observed in CZ-specific plots. These evolving and geographically variable patterns of antimicrobial resistance at finer spatial scales highlight the need for local surveillance and outpatient antibiotic stewardship strategies that consider place-based sociodemographic, ecologic, and clinical factors.

This article explores how informal medicine sellers (IMSs) in Mexico City “contest” and “reassemble” antibiotic control standards in ways that both challenge and respond to antimicrobial resistance (AMR) governance. Drawing on ethnographic fieldwork, we examine the “rationales”—moral, political, economic, technoscientific, and practical—that IMSs invoke to justify bypassing antibiotic prescription, dispensing and accounting regulations, and the “practical tinkering” they perform to make antibiotics available and “appropriately” used under conditions of scarcity and oversight failure. Rather than viewing IMSs as simply breaking official rules, we adopt a “social life of standards” perspective to argue that their actions reflect localized enactments of antibiotic control—versions shaped by community needs, corruption, poverty, and distrust in public health infrastructures. These practices are ambivalent, blurring boundaries between public service and profit and systemic subversion and informal regulation. By tracking how IMSs adapt, collectivize, and sometimes deliver treatments, we show how antibiotic governance is reworked from below—not only in response to AMR, but also to structural exclusions from formal care. We argue that rather than treating IMS rationales and practices as part of the problem, they should be studied as grounded responses to systemic failure—and potential sources of insight for context-sensitive regulatory design.

Since the first report of erythromycin-resistant Bordetella pertussis (B. pertussis) in Arizona in 1994, macrolide-resistant strains have emerged worldwide, threatening pertussis control. This systematic review and meta-analysis aimed to quantify the prevalence and temporal trends of this resistance. Four databases (PubMed, Embase, Cochrane Library, Web of Science) were searched for studies on B. pertussis antimicrobial susceptibility through December 2024. Among 57 included studies (1994–2024), pooled resistance rates (breakpoint ≥32 mg/L) were: erythromycin 21% (95% CI 11–32%), azithromycin 25% (95% CI 12–40%), clarithromycin 15% (95% CI 4–30%), and clindamycin 49% (95% CI 28–70%). Subgroup analyses by country, year, and test method are presented. No trimethoprim/sulfamethoxazole (STX) resistance was reported. Six Japanese isolates showed high-level nalidixic acid resistance (MIC >256 mg/L). Seventy-seven studies contributed to MIC90 data for carbapenems, tetracyclines, aminoglycosides, quinolones, macrolides, cephalosporins, and others. Selected penicillins and intravenous third-generation cephalosporins demonstrated strong in vitro activity, suggesting alternative treatment options. Macrolide-resistant B. pertussis has increased significantly over the past decade. Due to the high burden of antibiotic resistance in China, enhanced surveillance is warranted, while continued monitoring in other countries also remains necessary.

Antimicrobial resistance is one of the biggest global health threats, demanding urgent action. However, the threat of AMR and the ability to respond to it are far from evenly distributed. In many parts of the global South, where infectious diseases are more common, healthcare systems are weaker, and the social conditions that shape health are more precarious, the effects of AMR are felt more acutely. Because AMR arises within these unequal conditions, rapid action alone is insufficient; attention to how costs and benefits are distributed, who is prioritised, and whose voices are heard is essential to ensure that efforts do not inadvertently deepen existing inequalities. Hence, as the world prepares to tackle this “complex wicked problem,” it needs to ensure that we not only make a quick transition but also a just one. The first step in ensuring a just AMR transition is examining the fairness of our current strategies. This study critically reviews the National Action Plans of the countries in the WHO Western Pacific Region to examine the extent to which ideas of justice are considered. Findings reveal that there are limited considerations for how the burden and benefits of actions are shared; decision-making is dominated by external and national actors within human health. Access to antibiotics is restricted across the spectrum without adequately expanding and strengthening alternatives. As NAPs undergo revision, there is a need to more consciously and explicitly integrate considerations of justice and equity to avoid unintended harm and ensure effective outcomes.

We aimed to describe the evolution of gonorrhea infection and its antimicrobial resistance patterns in the Prairie provinces compared to Canada between 1980 and 2022. Data was collected from publicly available sexually transmitted infection reports in Canada, Alberta, Saskatchewan, and Manitoba. We extracted the number and rates of gonorrhea cases; percentage of cases by sex, age, ethnicity, sexual orientation; and data on cases diagnosed by culture and antimicrobial resistance. Descriptive statistics and age–period–cohort effect analysis were used. Gonorrhea cases in Canada rose from 32.4 per 100 000 in 1992 to 92.3 in 2022. In 2020, 36.9% of gonorrhea cases in Canada were females, compared to 42.8% in Alberta, 55.3% in Saskatchewan and 56% in Manitoba. People aged ≥30 years represented 22.5% of cases in 1980, and 54.1% in 2022. By 2022, the proportion of Canadian cases detected by culture declined to less than 10%, and azithromycin resistance of N. gonorrhoeae isolates was 8.1%. Alberta, Manitoba, and Saskatchewan reported higher rates of gonorrhea compared to Canada, with a higher proportion of female cases in Manitoba and Saskatchewan. Rising antimicrobial resistance rates and decreased culture testing present significant concerns for gonorrhea control and surveillance.