2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T69e,The rapid rise of antimicrobial resistance (AMR) has emerged as a critical global health crisis, driven by the widespread emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens. This growing threat, coupled with the stagnation in the development of novel antibiotics, necessitates the investigation of alternative antimicrobial strategies. Plant-derived essential oils (EOs) have emerged as promising candidates due to their broad-spectrum antibacterial activity, multi-targeted mechanisms, and capacity to enhance the efficacy of existing antibiotics. Recent studies have underscored the potential of EOs in disrupting biofilms, inhibiting quorum sensing, modulating efflux pumps, and reversing resistance in a variety of bacterial pathogens, including those listed as priorities by the World Health Organization. Notably, many of these effects have been demonstrated against resistant strains isolated directly from clinical samples, thereby enhancing the translational significance of EOs. In addition to their antimicrobial properties, advances in analytical, omics-based, and microfluidic technologies have further elucidated the mechanisms of EOs and may accelerate their therapeutic development. Nevertheless, challenges such as variability in composition, lack of standardized testing protocols, and limited in vivo data continue to impede clinical application. Therefore, the aim of this scoping review is to critically examine the advances over the past decade in the antibacterial activity of plant EOs against clinical isolates, with a particular focus on their efficacy against resistant bacterial pathogens and their potential role in combating AMR.31:T6af,The rapid rise of antimicrobial resistance (AMR) has emerged as a critical global health crisis, driven by the widespread emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens. This growing threat, coupled with the stagnation in the development of novel antibiotics, necessitates the investigation of alternative antimicrobial strategies. Plant-derived essential oils (EOs) have emerged as promising candidates due to their broad-spectrum antibacterial activity, multi-targeted mechanisms, and capacity to enhance the efficacy of existing antibiotics. Recent studies have underscored the potential of EOs in disrupting biofilms, inhibiting quorum sensing, modulating efflux pumps, and reversing resistance in a variety of bacterial pathogens, including those listed as priorities by the World Health Organization. Notably, many of these effects have been demonstrated against resistant strains isolated directly from clinical samples, thereby enhancing the translational significance of EOs. In addition to their antimicrobial properties, advances in analytical, omics-based, and microfluidic technologies have further elucidated the mechanisms of EOs and may accelerate their therapeutic development. Nevertheless, challenges such as variability in composition, lack of standardized testing protocols, and limited in vivo data continue to impede clinical application. Therefore, the aim of this scoping review is to critically examine the advances over the past decade in the antibacterial activity of plant EOs against clinical isolates, with a particular focus on their efficacy against resistant bacterial pathogens and their potential role in combating AMR.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Antimicrobial Resistance: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Antimicrobial Resistance (condition). 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AMR-attributable mortality was highest in VAP (16.9%, 95% CI 13.0–20.9%), in children aged 5–14 years (11.7%, 95% CI 1.6–21.8%), and in lower-middle-income countries (10.7%, 95% CI 7.0–14.4%). Most carbapenem-resistant Gram-negative infections were treated with carbapenems (57.8%) or polymyxins (35.6%)—both suboptimal options.","limitations":"Hospitals were selected for standardised data-collection capacity, potentially over-representing better-resourced centres and under-representing the true burden in resource-limited settings. The study is observational, so attributable mortality estimates carry residual confounding risk. Quality-of-life outcomes and longer-term follow-up beyond 28 days were not captured.","practice_takeaway":"CRA and CRE infections carry the highest mortality and worst quality-of-life outcomes in Asian ICUs—yet most are still treated with carbapenems or polymyxins rather than newer targeted agents. Clinicians and health systems should prioritise equitable access to effective therapies (e.g., novel β-lactam/β-lactamase inhibitor combinations) and strengthen context-specific antimicrobial stewardship programmes, especially for paediatric and lower-middle-income country settings."}},{"doi":"10.3399/bjgp26x746217","pmid":"42532869","title":"The Strait of Hormuz and global antibiotic security","journal_title":"British Journal of General Practice","journal_issn":"0960-1643","published_at":"2026-07-30T00:00:00.000Z","url":"https://doi.org/10.3399/bjgp26x746217","source_score":10,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-04T18:18:13.022Z","updated_at":"2026-08-04T18:18:13.022Z","tags":[{"paper_doi":"10.3399/bjgp26x746217","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"category","value":"Primary Health Care","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"condition","value":"Antibiotic Shortage","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"modality","value":"Antibiotic","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"study_design","value":"Commentary","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"warning","value":"Study design classification as 'Commentary' is inferred from structure and journal section ('Life & Times'); the article itself does not explicitly label its design.","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"warning","value":"The geopolitical event (Strait of Hormuz closure, March 2026) is very recent; some supply-impact figures may be projections or estimates rather than confirmed outcomes.","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746217","tag_type":"warning","value":"This is an expert commentary, not an empirical study; all statistics are cited narratively without inline references in the provided text.","value_numeric":null}],"summaries":{"what_studied":"This commentary examines how the March 2026 closure of the Strait of Hormuz disrupted petrochemical feedstock supplies to Indian generic drug manufacturers, threatening global antibiotic availability and accelerating antimicrobial resistance (AMR) risks — particularly in conflict-affected settings.","key_result":"India supplies ~47% of US generic medicines by volume and depends on the Strait for ~40% of its crude oil imports; disruption can raise air cargo costs 200–350%, inventories cover only 30–60 days in many markets, ~10–15% of global pharmaceutical commerce flows through West Asian hubs, and European pharmacists have already reported price increases of up to 30% for medicines including antibiotics.","limitations":"This is an opinion/commentary piece without original data or a systematic review; figures cited (e.g., cargo cost increases, inventory days) are not individually sourced within the text; long-term supply impact remains speculative at time of writing.","practice_takeaway":"Clinicians should anticipate potential shortages of common first-line antibiotics and reinforce stewardship practices now to prevent unnecessary use of last-resort agents. Awareness of substandard or counterfeit medicines entering supply chains during shortages is critical for patient safety."}},{"doi":"10.1016/j.jgar.2026.07.024","pmid":"42526709","title":"Ciprofloxacin metabolites drive resistance development and biofilm changes in Pseudomonas aeruginosa and Staphylococcus aureus","journal_title":"Journal of Global Antimicrobial Resistance","journal_issn":"2213-7165","published_at":"2026-07-29T00:00:00.000Z","url":"https://doi.org/10.1016/j.jgar.2026.07.024","source_score":6,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-03T06:19:56.669Z","updated_at":"2026-09-03T06:19:56.669Z","tags":[{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"condition","value":"Biofilm-Associated Infection","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"condition","value":"Pseudomonas aeruginosa Infection","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"condition","value":"Staphylococcus aureus Infection","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"generic","value":"ciprofloxacin","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"level_of_evidence","value":"6","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"modality","value":"Fluoroquinolone","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"study_design","value":"In Vitro Experimental Study","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"warning","value":"No sample size (N) is applicable in the traditional sense — this is a laboratory strain study using bacterial reference strains, not human subjects.","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"warning","value":"Publication date (2026-07-29) is in the future relative to most training data but consistent with today's date provided (September 3, 2026).","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"warning","value":"The clinical implications suggested by the authors are speculative and require in vivo or epidemiological validation.","value_numeric":null},{"paper_doi":"10.1016/j.jgar.2026.07.024","tag_type":"warning","value":"The study design is in vitro only; level of evidence is set to 6 (laboratory/bench study) accordingly.","value_numeric":null}],"summaries":{"what_studied":"This study investigated how two major ciprofloxacin metabolites — 2-oxo ciprofloxacin (M3) and N-formyl ciprofloxacin (M4) — affect resistance development and biofilm characteristics in *P. aeruginosa* (PAO1) and *S. aureus* (ATCC 25923) after 30 days of subinhibitory co-culture exposure.","key_result":"In *S. aureus*, M3 and M4 caused 8-fold and 4-fold increases in ciprofloxacin MIC, respectively. In *P. aeruginosa*, MICs were unchanged but both metabolites significantly enhanced biofilm formation (M4: P<0.0001; M3: P=0.0089); M3 exposure also selected a missense mutation (A290D) in *wspA*, activating cyclic-di-GMP biofilm pathways, and RNA-seq revealed 220 differentially expressed genes including upregulation of *rhlI*, *pqsH*, *nir*, *norCB*, and the *pel* operon.","limitations":"- Only two reference strains (PAO1, ATCC 25923) were used — clinical isolate diversity is not represented.\n- The ecological relevance of metabolite concentrations used in vitro (subinhibitory, 30-day exposure) to real-world human or environmental exposures is not established.\n- The study is largely mechanistic and does not include in vivo validation of resistance or persistence outcomes.","practice_takeaway":"Ciprofloxacin metabolites excreted after antibiotic use may independently drive resistance and biofilm adaptation in key pathogens, even at concentrations too low to kill bacteria. Clinicians and stewardship programs should consider the broader ecological footprint of fluoroquinolone metabolites, particularly in environments with chronic or recurrent ciprofloxacin exposure."}},{"doi":"10.1093/ofid/ofag407","pmid":"42483031","title":"US Adults’ Perspectives on Antibiotic Durations and Adherence to Therapy for Common Bacterial Respiratory Infections: A National Survey","journal_title":"Open Forum Infectious Diseases","journal_issn":"2328-8957","published_at":"2026-07-21T00:00:00.000Z","url":"https://doi.org/10.1093/ofid/ofag407","source_score":100,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-19T06:28:55.264Z","updated_at":"2026-08-19T06:28:55.264Z","tags":[{"paper_doi":"10.1093/ofid/ofag407","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"category","value":"Immunology","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"condition","value":"Bacterial Respiratory Infection","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"modality","value":"Antibiotic Therapy","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"sample_size","value":"n=1475","value_numeric":1475},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"study_design","value":"Cross-Sectional Survey","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"warning","value":"Results are specific to bacterial respiratory infections; authors caution that findings may not generalize to other infection types (e.g., UTI) or to non-English-speaking populations.","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"warning","value":"The binary short (3–5 days) vs. long (≥7 days) framing used in the survey may have artificially polarized responses; preferences for intermediate durations (e.g., 6 days) were not captured.","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag407","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the public health and communication implications highlighted by the authors, not a clinical trial result—the study design is observational and cannot establish causation.","value_numeric":null}],"summaries":{"what_studied":"A national online survey of 1,475 US adults (March–April 2024) examined preferences for antibiotic course length (short: 3–5 days vs. long: ≥7 days) and beliefs about adherence for common bacterial respiratory infections, along with factors associated with those preferences.","key_result":"60.4% of respondents preferred longer antibiotic courses (≥7 days); 63.0% rated longer courses as more effective and 61.5% as safer than shorter ones; 88.4% believed it is always important to finish a full antibiotic course. On multivariable analysis, preference for longer courses was associated with older age, greater trust in clinician advice, having been told to 'always finish' antibiotics, less concern about side effects, and lower comfort with early stopping.","limitations":"Cross-sectional, English-only, online design limits generalizability; binary 'short' vs. 'long' framing may have biased responses and missed intermediate preferences (e.g., 6-day courses); findings are restricted to respiratory infections and rely on self-report, which is subject to recall and social desirability bias.","practice_takeaway":"Most patients still hold the outdated 'always finish the full course' belief, driven largely by prior clinician advice—making the prescribing encounter a key lever for change. Clinicians should explicitly explain the rationale for shorter courses, normalize evolving evidence, and communicate the real risks of unnecessary antibiotic use to shift patient expectations toward guideline-concordant short-duration therapy."}},{"doi":"10.1001/jamapediatrics.2026.2808","pmid":"42475107","title":"Childhood Antimicrobial Resistance With Global Forecasts","journal_title":"JAMA Pediatrics","journal_issn":"2168-6203","published_at":"2026-07-20T00:00:00.000Z","url":"https://doi.org/10.1001/jamapediatrics.2026.2808","source_score":134,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-25T13:57:39.406Z","updated_at":"2026-07-25T13:57:39.406Z","tags":[{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"age_group","value":"infant","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"age_group","value":"neonate","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"category","value":"Pediatrics","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"condition","value":"Pediatric Pneumonia","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"condition","value":"Pediatric Sepsis","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"modality","value":"Antibiotic (AWaRe Access Group)","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"modality","value":"Antibiotic (AWaRe Reserve Group)","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"modality","value":"Antibiotic (AWaRe Watch Group)","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"modality","value":"Carbapenem","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"modality","value":"Cephalosporin","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"sample_size","value":"n=106581","value_numeric":106581},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"study_design","value":"Surveillance Study","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"warning","value":"Level of evidence assigned as '3' (cohort/surveillance study); no randomization or control group — causal inferences are not supported.","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"warning","value":"The ATLAS database is industry-sponsored (Pfizer); potential submission and selection bias toward hospital-based, higher-income settings may underestimate true resistance burden in low-resource regions.","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.2808","tag_type":"warning","value":"The study uses linear and nonlinear projection models to forecast to 2035; these are estimates with wide uncertainty intervals and should not be treated as definitive predictions.","value_numeric":null}],"summaries":{"what_studied":"This multiregional surveillance study analyzed AMR trends in 106,581 pediatric bacterial isolates (ages 0–18) from 82 countries using the ATLAS database (2004–2022), categorized by WHO AWaRe antibiotic groups, region, age, care setting, and infection type.","key_result":"Pediatric AMR rose in all regions from 2004–2022; ICU Watch-group resistance doubled (15% → 33%, P<.001). By 2035, carbapenem resistance is projected at 35% (95% UI 29%–40%) for *Klebsiella* spp. and 82% (95% UI 77%–85%) for *A. baumannii*. Resistance was highest in resource-limited settings, and infants aged 0–2 saw the steepest ICU Watch-group increases (12% → 32%, P<.001).","limitations":"- ATLAS is a commercial surveillance database and may not fully represent resource-limited settings where AMR is rising fastest.\n- Only isolates submitted to the database are analyzed — susceptibility testing and submission practices vary by country, risking selection bias.\n- Projections to 2035 carry wide uncertainty intervals and assume continuation of current trends.","practice_takeaway":"Empiric regimens for pediatric sepsis and pneumonia — especially in ICUs and low-resource settings — are under increasing threat; clinicians should audit local resistance patterns for *Klebsiella* spp. and *A. baumannii* and anticipate shrinking carbapenem efficacy over the next decade. Stewardship efforts targeting Watch- and Reserve-group antibiotics in neonates and young infants are urgently needed."}},{"doi":"10.1016/s1473-3099(26)00227-6","pmid":"42419333","title":"The spread of sexually transmissible drug-resistant shigellosis in England: a genomic epidemiology study","journal_title":"The Lancet Infectious Diseases","journal_issn":"1473-3099","published_at":"2026-07-08T00:00:00.000Z","url":"https://doi.org/10.1016/s1473-3099(26)00227-6","source_score":92,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-11T13:33:04.281Z","updated_at":"2026-07-11T13:33:04.281Z","tags":[{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"condition","value":"Sexually Transmissible Infection","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"condition","value":"Shigellosis","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"generic","value":"azithromycin","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"generic","value":"ceftriaxone","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"modality","value":"Antimicrobial Stewardship","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"sample_size","value":"n=3514","value_numeric":3514},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"study_design","value":"Genomic Epidemiology Study","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"warning","value":"pMSM (presumptive MSM) classification is proxy-based; actual sexual behaviour was not confirmed, which may affect precision of group-specific estimates.","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"warning","value":"Study design is observational/genomic; causal inference about resistance drivers (e.g., gonorrhoea treatment guidelines) is associative, not experimental.","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00227-6","tag_type":"warning","value":"The primary surveillance period ends February 2020; the XDR secondary analysis extends to December 2021 but uses a different, smaller subset (n=468), so XDR findings should be interpreted separately.","value_numeric":null}],"summaries":{"what_studied":"This genomic epidemiology study characterised the transmission dynamics and antimicrobial resistance (AMR) fitness of *Shigella sonnei* in England using 3,514 isolates from national surveillance (Sept 2004–Feb 2020), comparing spread and transmission intensity across presumptive MSM (pMSM), non-pMSM, and high-risk travel-associated cases, with a secondary analysis of extensively drug-resistant (XDR) emergence (2016–2021).","key_result":"Sexually transmitted *S. sonnei* spread significantly faster (mean pairwise spatial distance at ≤2.5 years: pMSM 117.4 km vs. non-pMSM 45.8 km, p<0.0001) and generated 100 more transmission chains per given population size (95% CI 41–171, p=0.0020) than domestically acquired non-sexual cases. Azithromycin-resistant isolates showed 1.71× relative fitness growth in pMSM networks, and ceftriaxone resistance was linked to XDR clade emergence.","limitations":"- pMSM classification is presumptive (proxy based on age/sex/travel history), not confirmed by self-reported sexual behaviour data.\n- Study period ends Feb 2020, predating COVID-19 disruptions to sexual networks and gonorrhoea treatment guideline changes that may affect current dynamics.\n- Findings are from England/UK, limiting direct generalisability to other high-income settings with different sexual health infrastructure.","practice_takeaway":"Standard enteric disease prevention (handwashing, food hygiene) will not curb sexually transmitted shigellosis in MSM — clinicians should treat it as a distinct STI requiring tailored interventions and stewardship. The fitness advantage of azithromycin and ceftriaxone resistance in this population signals an urgent need to coordinate AMR strategies across shigellosis and gonorrhoea treatment guidelines."}},{"doi":"10.1016/s1473-3099(26)00169-6","pmid":"42296975","title":"Effect of a community-based behavioural intervention bundle to improve antibiotic use and patient management in Burkina Faso and DR Congo (CABU-EICO): a cluster-randomised controlled trial","journal_title":"The Lancet Infectious Diseases","journal_issn":"1473-3099","published_at":"2026-06-15T00:00:00.000Z","url":"https://doi.org/10.1016/s1473-3099(26)00169-6","source_score":6,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-20T13:24:48.898Z","updated_at":"2026-06-20T13:24:48.898Z","tags":[{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"condition","value":"Community-Acquired Infections","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"modality","value":"Antibiotic Stewardship","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"modality","value":"Behavioural Intervention","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"sample_size","value":"n=10430","value_numeric":10430},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"study_design","value":"Cluster-Randomised Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"warning","value":"Sample size of n=10,430 reflects combined baseline and post-intervention patient surveys; the trial enrolled 44 clusters (villages/neighbourhoods), not individual participants as the primary unit. Numeric tag approximates total surveyed patients across both periods (5,532 + 4,898).","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"warning","value":"Substantial baseline imbalance in Watch-group antibiotic prevalence between intervention (26.8%) and control (13.4%) arms is noteworthy; authors used adjusted analysis but this difference may affect interpretation of effect size.","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00169-6","tag_type":"warning","value":"The study is registered and published but today's date (June 20, 2026) is only days after the listed publication date (June 15, 2026); full data may not yet be widely peer-reviewed or replicated.","value_numeric":null}],"summaries":{"what_studied":"A cluster-randomised controlled trial in Burkina Faso and DR Congo evaluated whether a co-created community-based intervention bundle (health education campaigns + provider education/feedback on WHO AWaRe guidance, over 9 months) reduced Watch-group antibiotic use and improved patient management across all community-level health-care providers.","key_result":"Watch-group antibiotic use fell from 26.8% to 17.1% in the intervention group but rose from 13.4% to 21.2% in controls (adjusted prevalence ratio 0.33, 95% CI 0.14–0.78); patient management scores showed minimal change in either group.","limitations":"Baseline Watch-group antibiotic prevalence differed notably between arms (26.8% vs 13.4%), raising concerns about comparability. Providers with fewer than 20 completed surveys were excluded, potentially limiting generalisability. Simulated patient visits may not fully reflect real-world prescribing behaviour.","practice_takeaway":"A multi-round community and provider education programme using WHO AWaRe guidance can cut Watch-group (broad-spectrum) antibiotic use by roughly two-thirds without harming patient care. Health systems in sub-Saharan Africa should consider scaling co-created AWaRe-based stewardship to informal and private community providers, not just formal facilities."}},{"doi":"10.1093/ofid/ofag338","pmid":null,"title":"Digital Tattoos\n in Infectious Diseases Management","journal_title":"Open Forum Infectious Diseases","journal_issn":"2328-8957","published_at":"2026-06-02T00:00:00.000Z","url":"https://doi.org/10.1093/ofid/ofag338","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-06-08T13:46:41.707Z","updated_at":"2026-06-08T13:46:41.707Z","tags":[{"paper_doi":"10.1093/ofid/ofag338","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"condition","value":"HIV","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"condition","value":"Penicillin Allergy","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"condition","value":"Sexually Transmitted Infections","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"generic","value":"penicillin","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"modality","value":"Antimicrobial Stewardship","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"study_design","value":"Commentary","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"warning","value":"No primary data or systematic review — this is an expert opinion piece; the impact_flag 'practice_changing' reflects the novelty and urgency of the concept rather than empirical evidence.","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"warning","value":"Sample size tag omitted as no study population is reported.","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag338","tag_type":"warning","value":"Sex tag omitted as the paper discusses general patient populations without sex-specific data.","value_numeric":null}],"summaries":{"what_studied":"This commentary examines how persistent EMR labels — termed 'Digital Tattoos' — related to antimicrobial-resistant organism colonization, HIV/STI status, and antibiotic allergy (e.g., penicillin) can outlive their clinical relevance and harm patients.","key_result":"Static EMR records misalign with dynamic clinical conditions, leading to unnecessary isolation, overuse of broad-spectrum antimicrobials, psychological distress, higher costs, and reinforced stigma — particularly for penicillin allergy labels that persist despite most reported allergies waning over time.","limitations":"This is an opinion/commentary piece with no primary data, no quantified outcomes, and no formal systematic review; recommendations for automated reassessment and de-labeling protocols are proposed but not empirically tested.","practice_takeaway":"Clinicians should actively review and update legacy EMR labels — especially penicillin allergy, AMR colonization, and HIV/STI status — rather than treating them as permanent. Health systems should consider building automated reassessment and de-labeling workflows into EMR infrastructure."}},{"doi":"10.1093/cid/ciag275","pmid":"42227749","title":"Mortality and Length of Stay Associated With Community-Acquired\n Escherichia coli\n and\n Staphylococcus aureus\n Bloodstream Infections: An Observational Study in 9 Low- and Middle-Income Countries","journal_title":"Clinical Infectious Diseases","journal_issn":"1058-4838","published_at":"2026-06-02T00:00:00.000Z","url":"https://doi.org/10.1093/cid/ciag275","source_score":11,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-11T13:43:03.930Z","updated_at":"2026-06-11T13:43:03.930Z","tags":[{"paper_doi":"10.1093/cid/ciag275","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"condition","value":"Escherichia coli Bloodstream Infection","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"condition","value":"MRSA Bacteremia","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"condition","value":"Staphylococcus aureus Bloodstream Infection","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"modality","value":"Methicillin","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"modality","value":"Third-Generation Cephalosporin","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"sample_size","value":"n=22802","value_numeric":22802},{"paper_doi":"10.1093/cid/ciag275","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"study_design","value":"Prospective Observational Cohort Study","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"warning","value":"Level of evidence set to 3 (prospective observational cohort); the competing-risks design strengthens causal inference but cannot fully adjust for unmeasured confounders.","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"warning","value":"Sample size reflects total blood cultures drawn (22,802), not total enrolled patients; the exact patient denominator for the control group is not specified in the abstract.","value_numeric":null},{"paper_doi":"10.1093/cid/ciag275","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied cautiously — the null finding on resistance-attributable mortality challenges common assumptions but is from a single multi-site observational study without randomization.","value_numeric":null}],"summaries":{"what_studied":"Prospective clinical surveillance (ACORN2) in adults and children across 9 low- and middle-income countries compared in-hospital mortality and length of stay (LOS) for community-acquired *E. coli* (3GC-susceptible vs. 3GC-resistant) and *S. aureus* (MSSA vs. MRSA) bloodstream infections (BSIs) against blood culture-negative controls, using cause-specific hazard models for competing events.","key_result":"Antimicrobial-resistant BSIs were **not** associated with higher mortality than susceptible BSIs or controls: adjusted HRs for death were 1.38 (95% CI, 0.99–1.94) for 3GC-R *E. coli* and 1.00 (95% CI, 0.61–1.66) for MRSA vs. controls. Resistant infections had only marginally longer LOS (2 days for *E. coli*; 1 day for *S. aureus*), with CIs spanning zero.","limitations":"- Control group is blood culture-negative (not truly uninfected), which may underestimate true attributable mortality.\n- Confidence intervals for LOS differences cross zero, limiting conclusions about extended stay.\n- Single-study design across heterogeneous LMIC settings may limit generalizability within or across specific countries.","practice_takeaway":"In LMICs, 3GC-resistant *E. coli* and MRSA BSIs did not carry higher mortality risk than their susceptible counterparts — the overall BSI burden, not resistance alone, drives death risk. Clinicians should prioritize early, adequate empiric therapy for all BSIs rather than focusing mortality risk reduction efforts solely on resistant strains."}},{"doi":"10.3390/antibiotics15060564","pmid":null,"title":"Current State of the Fight Against Antimicrobial Resistance: What Are the Different Strategies for Tomorrow?","journal_title":"Antibiotics","journal_issn":"2079-6382","published_at":"2026-06-01T00:00:00.000Z","url":"https://doi.org/10.3390/antibiotics15060564","source_score":25,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-06-12T13:24:37.627Z","updated_at":"2026-06-12T13:24:37.627Z","tags":[{"paper_doi":"10.3390/antibiotics15060564","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"brand","value":"Xacduro","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"condition","value":"Gram-Negative Bacterial Infection","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"condition","value":"Urinary Tract Infection","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"generic","value":"aztreonam/avibactam","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"generic","value":"colistin","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"generic","value":"gepotidacin","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"generic","value":"lariocidin","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"generic","value":"sulbactam/durlobactam","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"modality","value":"Antivirulence Agent","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"modality","value":"Bacteriophage Therapy","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"modality","value":"Beta-Lactam / Beta-Lactamase Inhibitor Combination","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"modality","value":"Fluoroquinolone-Class Antibiotic","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"warning","value":"Brand name 'Xacduro' is tagged for sulbactam/durlobactam based on known regulatory approval; it is not explicitly mentioned in the abstract text.","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"warning","value":"Gepotidacin is described as 'first-in-class' — its exact mechanism (bacterial type II topoisomerase inhibitor) is not explicitly stated in the available abstract text; tag reflects what the abstract supports.","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"warning","value":"The full text retrieved in the document body is a 2011 CMAJ commentary on NDM-1 (Walsh TR), not the 2026 Antibiotics review described in the abstract. Summaries and tags are therefore based primarily on the abstract; specific data points from the full review body could not be verified.","value_numeric":null},{"paper_doi":"10.3390/antibiotics15060564","tag_type":"warning","value":"The 'practice_changing' impact flag is applied based on newly approved agents described in the abstract; clinical impact assessment is limited without access to the actual full review text.","value_numeric":null}],"summaries":{"what_studied":"This 2026 narrative review examines the current AMR landscape — including resistance mechanisms, novel antibiotic approvals, and emerging strategies such as phage therapy, antivirulence approaches, and AI-guided drug discovery — alongside global policy and stewardship priorities.","key_result":"WHO data cited indicate 1 in 6 laboratory-confirmed bacterial infections shows resistance to at least one antibiotic. Recently approved agents highlighted include sulbactam/durlobactam, aztreonam/avibactam, and gepotidacin (first-in-class for UTIs), alongside novel scaffold lariocidin.","limitations":"This is a narrative review without systematic search methods or meta-analytic pooling, limiting the strength of evidence synthesis. The full text retrieved is mismatched (a 2011 CMAJ commentary on NDM-1), so some details from the actual review cannot be fully verified.","practice_takeaway":"New antibiotic/inhibitor combinations (sulbactam/durlobactam, aztreonam/avibactam) and gepotidacin are now regulatory-approved options for highly resistant Gram-negative infections and UTIs — clinicians should be aware of these additions to the formulary. Embedding antimicrobial stewardship into everyday prescribing remains essential to preserve Medically Important Antimicrobials."}},{"doi":"10.1093/jac/dkag182","pmid":"42219900","title":"In vitro\n exposure to non-antipseudomonal antibiotics (NAPA) induces\n Pseudomonas aeruginosa\n resistance to antipseudomonal antibiotics (APA)","journal_title":"Journal of Antimicrobial Chemotherapy","journal_issn":"0305-7453","published_at":"2026-06-01T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13223064/","source_score":9,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-11T13:43:07.453Z","updated_at":"2026-06-11T13:43:07.453Z","tags":[{"paper_doi":"10.1093/jac/dkag182","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"condition","value":"Pseudomonas aeruginosa Infection","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"generic","value":"ceftazidime","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"generic","value":"ceftriaxone","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"generic","value":"ciprofloxacin","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"generic","value":"ertapenem","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"generic","value":"meropenem","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"generic","value":"moxifloxacin","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"level_of_evidence","value":"6","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"modality","value":"Carbapenem","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"modality","value":"Cephalosporin","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"modality","value":"Fluoroquinolone","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"sample_size","value":"n=3","value_numeric":3},{"paper_doi":"10.1093/jac/dkag182","tag_type":"study_design","value":"In Vitro Directed Evolution Study","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"warning","value":"Age group and sex tags are not applicable — this is a pure in vitro microbiology study with no human or animal subjects.","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"warning","value":"Level of evidence rated 6 (in vitro/laboratory study); the study design does not fit standard clinical evidence hierarchies cleanly.","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"warning","value":"Not all elevated MIC observations had a corresponding identified genomic mutation, suggesting incomplete mechanistic explanation.","value_numeric":null},{"paper_doi":"10.1093/jac/dkag182","tag_type":"warning","value":"Sample size is only 3 bacterial strains; findings may not generalize across diverse clinical P. aeruginosa lineages.","value_numeric":null}],"summaries":{"what_studied":"Three *P. aeruginosa* strains (ATCC 27853 + 2 bloodstream isolates) were serially passaged for 11 days at subinhibitory concentrations (MIC/3) of non-antipseudomonal antibiotics (ertapenem, ceftriaxone, moxifloxacin), followed by a 3-day antibiotic-free recovery; MICs against antipseudomonal agents (meropenem, ceftazidime, ciprofloxacin) and whole-genome sequencing were tracked longitudinally.","key_result":"Subinhibitory NAPA exposure reproducibly raised antipseudomonal MICs: ertapenem → up to 29-fold meropenem increase; ceftriaxone → up to 31-fold ceftazidime increase; moxifloxacin → up to 12-fold ciprofloxacin increase. Elevated MICs persisted 3 days after antibiotic removal (Day 14). Convergent mutations in efflux regulators (*nfxB*, *nalC*, *nalD*, *amrR*) and *dacB* (AmpC regulator) were detected across all strains and antibiotic exposures.","limitations":"- In vitro only; clinical relevance of subinhibitory concentrations achievable at infection sites is unconfirmed.\n- WGS performed on 1–2 colonies per timepoint, risking underdetection of heteroresistant subpopulations.\n- Proteomic or transcriptomic resistance mechanisms (independent of stable SNPs) were not assessed.","practice_takeaway":"Antibiotics commonly regarded as 'Pseudomonas-sparing' (ertapenem, ceftriaxone, moxifloxacin) can select for heritable multidrug resistance in *P. aeruginosa* even at subinhibitory exposures. Clinicians should reconsider prior NAPA exposure as a potential risk factor for antipseudomonal resistance when choosing empiric therapy."}},{"doi":"10.1080/22221751.2026.2648890","pmid":"41852278","title":"Stepwise phage resistance and collateral phage susceptibility in\n Klebsiella pneumoniae","journal_title":"Emerging Microbes & Infections","journal_issn":"2222-1751","published_at":"2026-05-29T00:00:00.000Z","url":"https://doi.org/10.1080/22221751.2026.2648890","source_score":3,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-08T13:46:39.533Z","updated_at":"2026-06-08T13:46:39.533Z","tags":[{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"category","value":"Immunology","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"condition","value":"Carbapenem-Resistant Klebsiella Pneumoniae Infection","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"generic","value":"phage P04","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"generic","value":"phage P40","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"generic","value":"phage P49","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"modality","value":"Bacteriophage Therapy","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"modality","value":"Phage Cocktail","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"study_design","value":"Laboratory Experimental Study","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"warning","value":"Age group and sex tags are not applicable — this is a microbiological study with no human participants.","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"warning","value":"Sample size tag omitted: no single patient or strain N serves as a primary study N — the study used one index CRKP strain (135077) plus targeted panels of 31 CRKP and 20 Enterobacteriaceae strains for host-range testing.","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects a novel conceptual framework (collateral susceptibility via stepwise phage recovery); direct clinical translation has not been validated.","value_numeric":null},{"paper_doi":"10.1080/22221751.2026.2648890","tag_type":"warning","value":"This is a preclinical in vitro study; no animal models or clinical cases are reported. Growth-suppression durations reflect OD-based assays, not infection outcomes.","value_numeric":null}],"summaries":{"what_studied":"This study used a stepwise phage isolation strategy against ST11-KL64 carbapenem-resistant *Klebsiella pneumoniae* (CRKP), sequentially recovering three lytic phages (P04, P40, P49) from different families and combining them into a cocktail, then characterizing the resistance mechanisms and receptor biology of each phage.","key_result":"The three-phage cocktail (P04 + P40 + P49) restrained CRKP growth for 15 h versus ~8 h for two phages and ~4 h for one. Resistance to P40 required loss of *ugd*/*wbgU* genes (mediating lipid A modification), driven by IS903B/ISKpn26 homologous recombination causing 18–52 kb deletions. Phage P49 targeted BtuB (vitamin B12 transporter) and showed rare cross-genus lysis of *S. enterica*, *E. coli*, *E. ludwigii*, and *K. tianfuensis* — active only when CPS was absent, because CPS physically shields BtuB.","limitations":"- The exact molecular mechanism by which *ugd*/*wbgU* loss alters lipid A to block P40 adsorption (unidentified receptor) remains unclear.\n- P49 cross-genus findings are based on a limited strain panel, and CPS shielding of BtuB prevents direct structural comparison between lysed and non-lysed strains.\n- Results are restricted to ST11-KL64 CRKP; dominant lineages differ geographically, so the three-phage scheme is not a universal solution.","practice_takeaway":"Building phage cocktails stepwise — using each round of phage-resistant mutants as the host to isolate the next phage — can extend bacterial growth suppression and exploit 'collateral susceptibility,' where capsule loss exposes conserved receptors (like BtuB) to phages normally targeting other species. Clinicians assembling phage cocktails for CRKP should consider screening phages that target *Salmonella* or *E. coli* as potential candidates once the organism loses its capsule."}},{"doi":"10.3201/eid3206.251404","pmid":"42230315","title":"Increase in\n bla\n _NDM\n among Carbapenemase-Producing, Carbapenem-Resistant Enterobacterales, United States, 2016–2023","journal_title":"Emerging Infectious Diseases","journal_issn":"1080-6040","published_at":"2026-05-27T00:00:00.000Z","url":"https://doi.org/10.3201/eid3206.251404","source_score":10,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-03T13:44:43.706Z","updated_at":"2026-06-03T13:44:43.706Z","tags":[{"paper_doi":"10.3201/eid3206.251404","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"condition","value":"Carbapenem-Resistant Enterobacterales","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"generic","value":"aztreonam-avibactam","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"generic","value":"cefiderocol","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"generic","value":"ceftazidime-avibactam","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"generic","value":"imipenem-relebactam","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"generic","value":"meropenem-vaborbactam","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"modality","value":"Carbapenem","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"sample_size","value":"n=1288","value_numeric":1288},{"paper_doi":"10.3201/eid3206.251404","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"study_design","value":"Surveillance Study","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"warning","value":"Sex and age-group data were not explicitly reported in the abstract or text; 'mixed' is assumed based on population-based hospital surveillance context.","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"warning","value":"Study design was classified as a surveillance/observational study — not a traditional clinical trial; level of evidence is moderate.","value_numeric":null},{"paper_doi":"10.3201/eid3206.251404","tag_type":"warning","value":"This is a convenience sample from 10 EIP sites; findings may not represent national incidence trends.","value_numeric":null}],"summaries":{"what_studied":"Trends in carbapenemase gene types among 1,288 carbapenemase-producing, carbapenem-resistant Enterobacterales (CP-CRE) collected across 10 U.S. CDC Emerging Infections Program sites from 2016 to 2023, using real-time PCR and broth microdilution.","key_result":"The proportion of isolates harboring *bla*NDM rose sharply from 5.4% (n=6) in 2016 to 39.8% (n=99) in 2023 (p<0.00001), while *bla*KPC fell from 92.8% to 53.0% over the same period. The shift was most pronounced in *E. coli*, where NDM accounted for 73% of all carbapenemase-producing *E. coli* by 2023 (vs. 14.3% in 2016).","limitations":"- Convenience sample from only 10 EIP sites; national trends cannot be reliably extrapolated.\n- Cannot determine whether the incidence (absolute case counts) of NDM-producing CRE changed, only the proportion among submitted isolates.\n- Whole-genome sequencing was not performed, so gene variants and clonal vs. horizontal spread cannot be distinguished.","practice_takeaway":"Clinicians should be aware that NDM-producing CRE are rising rapidly in the U.S. and are not covered by newer β-lactam/β-lactamase inhibitor combinations (ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam). Clinical labs should prioritize carbapenemase mechanism testing to guide treatment decisions."}},{"doi":"10.1016/j.ijantimicag.2026.107849","pmid":"42208776","title":"Burden and Global Distribution of Antimicrobial Resistance in Non-Bloodstream Infections Among Adults with Cirrhosis: A Systematic Review and Proportional Meta-Analysis","journal_title":"International Journal of Antimicrobial Agents","journal_issn":"0924-8579","published_at":"2026-05-27T00:00:00.000Z","url":"https://doi.org/10.1016/j.ijantimicag.2026.107849","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-07T13:26:34.707Z","updated_at":"2026-06-07T13:26:34.707Z","tags":[{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"condition","value":"Liver Cirrhosis","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"condition","value":"Spontaneous Bacterial Peritonitis","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"condition","value":"Urinary Tract Infection","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"generic","value":"broad-spectrum antibiotics","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"modality","value":"Antimicrobial Therapy","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"sample_size","value":"n=3162","value_numeric":3162},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"study_design","value":"Systematic Review and Meta-Analysis","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"warning","value":"Studies included both clinical infection isolates (n=2,781) and colonisation isolates (n=381); pooled resistance proportions may slightly overestimate or underestimate clinical infection-specific MDR rates.","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"warning","value":"The 'generic' tag for 'broad-spectrum antibiotics' is a class placeholder—no specific drug was evaluated as an intervention in this observational review.","value_numeric":null},{"paper_doi":"10.1016/j.ijantimicag.2026.107849","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied based on the striking income-stratified resistance differentials, but this is a surveillance/epidemiological study without a therapeutic intervention arm.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and proportional meta-analysis evaluated the global burden and distribution of antimicrobial resistance (AMR) in non-bloodstream bacterial infections (primarily spontaneous bacterial peritonitis and UTIs) among adults with cirrhosis, using studies published up to September 2025.","key_result":"Across 31 studies and 3,162 isolates, the pooled multidrug-resistance (MDR) proportion was 23% (95% CI: 13–37%). MDR was markedly higher in lower-middle-income countries (56% vs. 15–41% in higher-income settings), as were ESBL (24% vs. 8–10%), VRE (23% vs. 2%), and CRE (32% vs. 1%) rates. Gram-negatives dominated (60%; *E. coli* 29%, *K. pneumoniae* 11%); Gram-positives accounted for 39% (*Enterococcus* spp. 14%, *S. aureus* 6%). Genotypic analysis identified 436 resistance genes with continental variation.","limitations":"- 89% of isolates came from spontaneous bacterial peritonitis, limiting generalisability to other infection types.\n- Studies were observational and heterogeneous; pooled estimates used random-effects models, but residual heterogeneity across settings is likely.\n- Genotypic resistance data were available in only a subset of studies, restricting genomic conclusions.","practice_takeaway":"Clinicians managing infections in cirrhotic patients—especially in lower-middle-income countries—should anticipate high rates of MDR pathogens and calibrate empiric antibiotic regimens accordingly. Integrated phenotypic and genomic surveillance is needed to keep local treatment protocols current."}},{"doi":"10.1136/sextrans-2025-056896","pmid":"42167924","title":"Revisiting gonorrhoea prevention in the era of resistance and biomedical interventions","journal_title":"Sexually Transmitted Infections","journal_issn":"1368-4973","published_at":"2026-05-21T00:00:00.000Z","url":"https://doi.org/10.1136/sextrans-2025-056896","source_score":10,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-28T13:24:25.940Z","updated_at":"2026-05-28T13:24:25.940Z","tags":[{"paper_doi":"10.1136/sextrans-2025-056896","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056896","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056896","tag_type":"condition","value":"Gonorrhoea","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056896","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056896","tag_type":"warning","value":"Only the paper's metadata (title, DOI, journal, publication date) was provided — no abstract, methods, results, or conclusions were included. All structured fields requiring study content have been left null or set to the most conservative values. Full extraction requires the paper body or abstract.","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056896","tag_type":"warning","value":"Study design and level of evidence could not be determined from available metadata alone.","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056896","tag_type":"warning","value":"The 'limited_evidence' impact flag reflects the inability to assess findings, not a judgment on study quality.","value_numeric":null}],"summaries":{"what_studied":"This paper revisits strategies for gonorrhoea prevention in the current context of antimicrobial resistance and emerging biomedical interventions, evaluating approaches to reduce transmission and disease burden.","limitations":"The source text provided contains only the title, DOI, journal, and publication date — no abstract, methods, results, or conclusions are available to extract specific findings or limitations."}},{"doi":"10.1016/s1473-3099(26)00123-4","pmid":"42107388","title":"Durability of doxycycline effectiveness against gonorrhoea after implementation of post-exposure prophylaxis in southern California, USA: a retrospective, test-negative, observational study","journal_title":"The Lancet Infectious Diseases","journal_issn":"1473-3099","published_at":"2026-05-07T00:00:00.000Z","url":"https://doi.org/10.1016/s1473-3099(26)00123-4","source_score":15,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-13T13:19:25.857Z","updated_at":"2026-05-13T13:19:25.857Z","tags":[{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"condition","value":"Chlamydia","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"condition","value":"Gonorrhoea","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"condition","value":"Sexually Transmitted Infections","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"condition","value":"Syphilis","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"generic","value":"doxycycline","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"modality","value":"Post-Exposure Prophylaxis","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"modality","value":"Tetracycline Antibiotic","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"sample_size","value":"n=26582","value_numeric":26582},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"study_design","value":"Retrospective Observational Study (Test-Negative Design)","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"warning","value":"Effectiveness estimates for gonorrhoea sub-periods have wide confidence intervals, particularly for early pre-implementation phase (95% CI 2.7–65.8), limiting precision of temporal trend conclusions.","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"warning","value":"The study includes transgender women assigned male at birth, but sex tag is marked 'male' per biological assignment used in eligibility criteria — clinicians should note this population distinction.","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"warning","value":"The test-negative design controls for healthcare-seeking behaviour but cannot fully adjust for unmeasured sexual risk behaviour differences between doxy-PEP users and non-users.","value_numeric":null}],"summaries":{"what_studied":"This retrospective, test-negative observational study evaluated real-world effectiveness of doxycycline post-exposure prophylaxis (doxy-PEP) against chlamydia, gonorrhoea, and syphilis among 26,582 MSM and transgender women in Kaiser Permanente Southern California (Jan 2023–Jun 2025), and whether gonorrhoea effectiveness was durable over time as tetracycline resistance spread.","key_result":"Doxy-PEP was effective against chlamydia (66.5%, 95% CI 53.6–75.9) and syphilis (60.7%, 95% CI 28.3–78.5), but showed no meaningful protection against gonorrhoea overall (−1.8%, 95% CI −18.5 to 12.5). Gonorrhoea effectiveness dropped from 42.3% before statewide implementation to −15.0% by Jan–Jun 2025, closely tracking a rise in tetM prevalence: effectiveness fell from 47.2% when tetM was present in 20–29.9% of isolates to −8.5% when tetM reached ≥50% of isolates.","limitations":"- Observational design cannot fully exclude confounding (e.g., sexual behaviour differences between doxy-PEP users and non-users).\n- tetM prevalence data were derived from local surveillance isolates, which may not perfectly represent the full circulating strain population.\n- Doxy-PEP use was defined by prescription fills, not confirmed adherence or timing of doses.","practice_takeaway":"Clinicians prescribing doxy-PEP should counsel MSM and transgender women that protection against gonorrhoea may be minimal or absent in settings where tetracycline-resistant *N. gonorrhoeae* is prevalent (≥50% tetM). Sustained benefits against chlamydia and syphilis remain, so risk-benefit discussions should be individualized and local AMR surveillance data should inform ongoing doxy-PEP recommendations."}},{"doi":"10.3399/bjgp26x744837","pmid":"42062089","title":"Primary care in a destroyed health system: reflections on a deployment to Gaza","journal_title":"British Journal of General Practice","journal_issn":"0960-1643","published_at":"2026-05-01T00:00:00.000Z","url":"https://doi.org/10.3399/bjgp26x744837","source_score":5,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-09","doi":"10.3399/bjgp26x744837","days":"7","issn":"0960-1643","rank":"4","field":"Clinical Medicine","score":"5","category":"Primary Health Care","categories":["Primary Health Care"],"_categories":["Primary Health Care"]},"pubmed":{"doi":"10.3399/bjgp26X744837","title":"Primary care in a destroyed health system: reflections on a deployment to Gaza.","journal":"The British journal of general practice : the journal of the Royal College of General Practitioners","methods":"","results":"","abstract":"","keywords":[],"pubmed_id":"42062089","conclusions":"","publication_date":"2026-05-01T00:00:00"},"crossref":{"DOI":"10.3399/bjgp26x744837","URL":"https://doi.org/10.3399/bjgp26x744837","ISSN":["0960-1643","1478-5242"],"link":[{"URL":"https://syndication.highwire.org/content/doi/10.3399/bjgp26X744837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"224-225","type":"journal-article","issue":"766","score":1,"title":["Primary care in a destroyed health system: reflections on a deployment to Gaza"],"author":[{"given":"Richard","family":"Armitage","sequence":"first","affiliation":[]}],"issued":{"date-parts":[[2026,4,30]]},"member":"1987","prefix":"10.3399","source":"Crossref","volume":"76","created":{"date-time":"2026-05-01T00:40:38Z","timestamp":1777596038000,"date-parts":[[2026,5,1]]},"indexed":{"date-time":"2026-05-13T13:21:12Z","timestamp":1778678472177,"date-parts":[[2026,5,13]]},"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"http://bjgp.org/lookup/doi/10.3399/bjgp26X744837"}},"subtitle":[],"deposited":{"date-time":"2026-05-13T12:30:39Z","timestamp":1778675439000,"date-parts":[[2026,5,13]]},"issn-type":[{"type":"print","value":"0960-1643"},{"type":"electronic","value":"1478-5242"}],"published":{"date-parts":[[2026,4,30]]},"publisher":"Royal College of General Practitioners","reference":[{"DOI":null,"key":"2026051305300816000_76.766.224.1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"World Health Organization (2025) Health system at breaking point as hostilities further intensify in Gaza, WHO warns. accessed. https://www.who.int/news/item/22-05-2025-health-system-at-breaking-point-as-hostilities-further-intensify--who-warns. 7 Apr 2026.","article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":"10.1016/s0140-6736(23)02508-4","key":"2026051305300816000_76.766.224.2","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1186/s12866-025-04335-3","key":"2026051305300816000_76.766.224.3","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"}],"short-title":[],"journal-issue":{"issue":"766","published-print":{"date-parts":[[2026,5,1]]},"published-online":{"date-parts":[[2026,4,30]]}},"alternative-id":["10.3399/bjgp26X744837"],"content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["British Journal of General Practice"],"published-print":{"date-parts":[[2026,5,1]]},"reference-count":3,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,4,30]]},"references-count":3,"short-container-title":["Br J Gen Pract"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.3399/bjgp26x744837","is_oa":false,"title":"Primary care in a destroyed health system: reflections on a deployment to Gaza","updated":"2026-05-05T11:59:32+00:00","published_date":"2026-04-30","best_oa_location":null}},"created_at":"2026-05-10T13:20:53.510Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.3399/bjgp26x744837","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"category","value":"Primary Health Care","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"condition","value":"Healthcare System Collapse","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"condition","value":"Non-Communicable Disease Management","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"modality","value":"Antimicrobial Stewardship","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"modality","value":"Primary Care / General Practice","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"study_design","value":"Field Report / Narrative Reflection","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"warning","value":"Antimicrobial resistance statistics cited (70% multidrug resistance in wounds, up to 90% E. coli resistance) are drawn from referenced external studies, not from data collected during this deployment.","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"warning","value":"Study design label 'Field Report / Narrative Reflection' is non-standard; closest canonical category would be 'Expert Opinion' or 'Narrative Review'.","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744837","tag_type":"warning","value":"This is a personal narrative/opinion piece, not an original research study—no patient-level data or formal methodology is present. Level of evidence is assigned as 7 (expert opinion/field report).","value_numeric":null}],"summaries":{"what_studied":"A first-person field report by a British GP describing a 4-week humanitarian deployment to Gaza (January 2026), focusing on primary care delivery, health system collapse, digital infrastructure loss, and antimicrobial resistance in a conflict setting.","key_result":"As of May 2025, at least 94% of Gaza's hospitals had been damaged or destroyed (only 19 of 36 remained operational). Pre-existing antimicrobial resistance was severe—70% multidrug resistance in wound isolates and up to 90% resistance in *E. coli* isolates—worsened by overcrowding, poor sanitation, and medication shortages.","limitations":"Single-author narrative reflection with no systematic data collection; findings are observational and site-specific to one repurposed facility in Gaza City; no patient outcomes are reported.","practice_takeaway":"When deploying to conflict or disaster settings, prioritise locally adapted antimicrobial stewardship guidelines and basic documentation systems early—these foundational tools have outsized impact when the broader health infrastructure is gone. The loss of electronic health records in Gaza illustrates how deeply routine care depends on digital continuity."}},{"doi":"10.3399/bjgp26x744789","pmid":"42062079","title":"The inequality paradox: how gepotidacin addresses the hidden social gradient of antimicrobial resistance","journal_title":"British Journal of General Practice","journal_issn":"0960-1643","published_at":"2026-05-01T00:00:00.000Z","url":"https://doi.org/10.3399/bjgp26x744789","source_score":5,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-09","doi":"10.3399/bjgp26x744789","days":"7","issn":"0960-1643","rank":"6","field":"Clinical Medicine","score":"5","category":"Primary Health Care","categories":["Primary Health Care"],"_categories":["Primary Health Care"]},"pubmed":{"doi":"10.3399/bjgp26X744789","title":"The inequality paradox: how gepotidacin addresses the hidden social gradient of antimicrobial resistance.","journal":"The British journal of general practice : the journal of the Royal College of General Practitioners","methods":"","results":"","abstract":"","keywords":[],"pubmed_id":"42062079","conclusions":"","publication_date":"2026-05-01T00:00:00"},"crossref":{"DOI":"10.3399/bjgp26x744789","URL":"https://doi.org/10.3399/bjgp26x744789","ISSN":["0960-1643","1478-5242"],"link":[{"URL":"https://syndication.highwire.org/content/doi/10.3399/bjgp26X744789","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"219-219","type":"journal-article","issue":"766","score":1,"title":["The inequality paradox: how gepotidacin addresses the hidden social gradient of antimicrobial resistance"],"author":[{"given":"Yusuf","family":"Hussain","sequence":"first","affiliation":[]},{"given":"Niha","family":"Hussain","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,4,30]]},"member":"1987","prefix":"10.3399","source":"Crossref","volume":"76","created":{"date-time":"2026-05-01T00:40:38Z","timestamp":1777596038000,"date-parts":[[2026,5,1]]},"indexed":{"date-time":"2026-05-13T13:20:47Z","timestamp":1778678447744,"date-parts":[[2026,5,13]]},"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"http://bjgp.org/lookup/doi/10.3399/bjgp26X744789"}},"subtitle":[],"deposited":{"date-time":"2026-05-13T12:30:12Z","timestamp":1778675412000,"date-parts":[[2026,5,13]]},"issn-type":[{"type":"print","value":"0960-1643"},{"type":"electronic","value":"1478-5242"}],"published":{"date-parts":[[2026,4,30]]},"publisher":"Royal College of General Practitioners","reference":null,"short-title":[],"journal-issue":{"issue":"766","published-print":{"date-parts":[[2026,5,1]]},"published-online":{"date-parts":[[2026,4,30]]}},"alternative-id":["10.3399/bjgp26X744789"],"content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["British Journal of General Practice"],"published-print":{"date-parts":[[2026,5,1]]},"reference-count":0,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,4,30]]},"references-count":0,"short-container-title":["Br J Gen Pract"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.3399/bjgp26x744789","is_oa":false,"title":"The inequality paradox: how gepotidacin addresses the hidden social gradient of antimicrobial 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Infection","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"generic","value":"azithromycin","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"generic","value":"ceftriaxone","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"generic","value":"gepotidacin","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"generic","value":"nitrofurantoin","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"modality","value":"Triazaacenaphthylene Antibiotic","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"sample_size","value":"n=3628","value_numeric":3628},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"study_design","value":"Commentary","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"warning","value":"The 'practice_changing' impact flag reflects gepotidacin's novel class and non-inferiority trial results, but real-world prescribing guidance and formulary status in UK primary care had not been fully established at publication.","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"warning","value":"The sample size tag (n=3628) combines EAGLE-1 (628) and EAGLE-2/3 (>3000) trial populations, which studied different indications; these are not a single unified trial cohort.","value_numeric":null},{"paper_doi":"10.3399/bjgp26x744789","tag_type":"warning","value":"This is an opinion/commentary piece; the AMR socioeconomic disparity statistics are presented without primary source citation within the extracted text.","value_numeric":null}],"summaries":{"what_studied":"This commentary examines how gepotidacin, a first-in-class triazaacenaphthylene antibiotic, may address the socioeconomic gradient of antimicrobial resistance (AMR) in UTIs and gonorrhoea, drawing on phase III EAGLE trial data and UK AMR surveillance figures.","key_result":"In the EAGLE-2 and EAGLE-3 trials (>3,000 female patients), gepotidacin 1500 mg twice daily for 5 days was non-inferior to nitrofurantoin for UTIs; both trials were terminated early for efficacy. EAGLE-1 (n=628) showed 92.6% microbiological success vs. 91.2% for IM ceftriaxone plus oral azithromycin for gonorrhoea. In England (2024), patients in the lowest socioeconomic areas faced a 47.2% higher rate of antibiotic-resistant bloodstream infections vs. higher socioeconomic areas — a 29% increase since 2019.","limitations":"This is an opinion/commentary piece, not a primary study; it does not present original data. The socioeconomic AMR disparity figures are cited without formal statistical analysis. No cost-effectiveness or real-world access data for gepotidacin are discussed.","practice_takeaway":"GPs serving deprived communities should be aware that gepotidacin's oral route and activity against fluoroquinolone- and trimethoprim-resistant organisms may benefit patients who face barriers to parenteral therapy and carry higher resistant-organism burden. Each prescribing decision carries health equity implications beyond the individual patient."}},{"doi":"10.1021/acsinfecdis.5c00885","pmid":"41532636","title":"An Acetyltransferase Conferring Self-Resistance of the Producer to Lasso Peptide Antibiotic Lariocidin","journal_title":"ACS Infectious Diseases","journal_issn":"2373-8227","published_at":"2026-01-14T00:00:00.000Z","url":"https://doi.org/10.1021/acsinfecdis.5c00885","source_score":32,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-16","doi":"10.1021/acsinfecdis.5c00885","days":"7","issn":"2373-8227","rank":"4","field":"Clinical Medicine","score":"32","category":"Infectious Diseases","categories":["Infectious Diseases"],"_categories":["Infectious Diseases"]},"pubmed":{"doi":"10.1021/acsinfecdis.5c00885","title":"An Acetyltransferase Conferring Self-Resistance of the Producer to Lasso Peptide Antibiotic Lariocidin.","journal":"ACS infectious diseases","methods":"","results":"","abstract":"The soil microbiome, a reservoir of antibiotic-producing bacteria, also harbors resistance determinants encoded within antibiotic biosynthetic gene clusters (BGCs). Studying self-resistance mechanisms, which have evolved in producers to protect against their own toxic metabolites, provides critical insights into the evolution of resistance and the potential vulnerabilities of new antibiotics and can facilitate the production of natural products in heterologous hosts. Here, we describe the self-resistance mechanism to lariocidin (LAR), a recently discovered lasso peptide antibiotic that inhibits the ribosomal machinery and exhibits antibacterial activity against key pathogens. We identified and characterized an ","keywords":["RiPP","acetyltransferase","antibiotic","antibiotic resistance","inactivation","inhibitor","lariocidin","lasso peptide","ribosome"],"pubmed_id":"41532636","conclusions":"","publication_date":"2026-01-14T00:00:00"},"crossref":{"DOI":"10.1021/acsinfecdis.5c00885","URL":"https://doi.org/10.1021/acsinfecdis.5c00885","ISSN":["2373-8227","2373-8227"],"link":[{"URL":"https://pubs.acs.org/doi/pdf/10.1021/acsinfecdis.5c00885","content-type":"application/pdf","content-version":"vor","intended-application":"unspecified"},{"URL":"https://pubs.acs.org/doi/pdf/10.1021/acsinfecdis.5c00885","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["An Acetyltransferase Conferring Self-Resistance of the Producer to Lasso Peptide Antibiotic Lariocidin"],"author":[{"given":"Manoj","family":"Jangra","sequence":"first","affiliation":[{"name":"David Braley Centre for Antibiotic Discovery"},{"name":"McMaster University"},{"name":"M.G. DeGroote Institute for Infectious Disease Research"},{"name":"McMaster University"},{"name":"Department of Biochemistry and Biomedical Sciences"},{"name":"McMaster University"}]},{"given":"Dmitrii Y.","family":"Travin","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences"},{"name":"University of Illinois at Chicago"},{"name":"Center for Biomolecular Sciences"},{"name":"University of Illinois at Chicago"}]},{"given":"Manpreet","family":"Kaur","sequence":"additional","affiliation":[{"name":"David Braley Centre for Antibiotic Discovery"},{"name":"McMaster University"},{"name":"M.G. DeGroote Institute for Infectious Disease Research"},{"name":"McMaster University"},{"name":"Department of Biochemistry and Biomedical Sciences"},{"name":"McMaster University"}]},{"given":"Dirk","family":"Hackenberger","sequence":"additional","affiliation":[{"name":"David Braley Centre for Antibiotic Discovery"},{"name":"McMaster University"},{"name":"M.G. DeGroote Institute for Infectious Disease Research"},{"name":"McMaster University"},{"name":"Department of Biochemistry and Biomedical Sciences"},{"name":"McMaster University"}]},{"given":"Kalinka","family":"Koteva","sequence":"additional","affiliation":[{"name":"David Braley Centre for Antibiotic Discovery"},{"name":"McMaster University"},{"name":"M.G. DeGroote Institute for Infectious Disease Research"},{"name":"McMaster University"},{"name":"Department of Biochemistry and Biomedical Sciences"},{"name":"McMaster University"}]},{"given":"Yury S.","family":"Polikanov","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences"},{"name":"University of Illinois at Chicago"},{"name":"Center for Biomolecular Sciences"},{"name":"University of Illinois at Chicago"},{"name":"Department of Biological Sciences"},{"name":"University of Illinois at Chicago"}]},{"given":"Gerard D.","family":"Wright","sequence":"additional","affiliation":[{"name":"David Braley Centre for Antibiotic Discovery"},{"name":"McMaster University"},{"name":"M.G. 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It also summarizes mechanisms (biofilm disruption, quorum-sensing inhibition, efflux pump modulation) and potential synergy with antibiotics.","limitations":"Essential oil composition varies between studies, testing protocols are not standardized, and in vivo data are limited, constraining clinical translation.","practice_takeaway":"Essential oils show in vitro activity against resistant clinical isolates and may boost antibiotic effects, but without standardized methods and in vivo evidence they remain investigational. Clinicians should not use them to guide treatment outside research settings."}}],"initialOffset":20,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Antimicrobial Resistance"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Antimicrobial Resistance"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Antimicrobial Resistance"}}}]]

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