Journal of global antimicrobial resistance最新文献

{"title":"Terrestrial plastisphere as a reservoir of high-risk mcr-1-positive Escherichia coli ST744 in a farmhouse","authors":"João Pedro Rueda Furlan , Rafael da Silva Rosa , Micaela Santana Ramos , Lucas David Rodrigues dos Santos , Eliana Guedes Stehling","doi":"10.1016/j.jgar.2025.11.015","DOIUrl":"10.1016/j.jgar.2025.11.015","url":null,"abstract":"","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 146-147"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145677860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial resistance in India: Integrating the response into health systems for universal health coverage","authors":"Sudha Chandrashekar ,&nbsp;Shambhavi Nimisha Prasad ,&nbsp;Ramesh Masthi N R ,&nbsp;Sheilja Walia ,&nbsp;Anushree Trikha ,&nbsp;Rajeev Sadanandan","doi":"10.1016/j.jgar.2025.12.001","DOIUrl":"10.1016/j.jgar.2025.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial resistance (AMR) poses a formidable threat to public health in India, requiring a multidimensional response that bridges policy, innovation and intersectoral collaborations. The rapid emergence and spread of multidrug-resistant pathogens driven by the misuse of antimicrobials in human health, animal health, agriculture and environmental settings has rendered many existing therapies obsolete, leaving the population vulnerable to untreatable infections.</div></div><div><h3>Objectives</h3><div>To examine the multifactorial drivers of AMR in India, review current national and state-level policies and explore the potential role of artificial intelligence (AI) in AMR surveillance, prevention and control.</div></div><div><h3>Methods</h3><div>This review synthesises evidence from published literature, reports and policy documents. It analyses AMR determinants across human, animal and environmental sectors, evaluates policy frameworks such as India’s National Action Plan and State Action Plans to combat AMR.</div></div><div><h3>Results</h3><div>Key AMR drivers include antibiotic misuse, inadequate regulation, over-the-counter availability, pharmaceutical and hospital wastewater contamination and gaps in infection prevention. India has come up with national and six state level action plans for AMR containment. The measures include stewardship programs, laboratory network strengthening, spreading awareness and intersectoral coordination. The role of AI in strengthening AMR surveillance and clinical decision-making by integrating complex, high-dimensional data for predictive modelling has been explored.</div></div><div><h3>Conclusion</h3><div>While India has made significant policy and surveillance advances, enforcement gaps, limited awareness and fragmented data hinder progress. Strengthening governance, expanding One Health surveillance, integrating AI and embedding AMR strategies into universal health coverage are critical to mitigating AMR’s health and economic burden.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 195-202"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcome comparison between adjunctive clindamycin vs. linezolid for invasive group A streptococcal infection","authors":"Eriko Hashimoto ,&nbsp;Sayaka Yoshida ,&nbsp;Taito Kitano","doi":"10.1016/j.jgar.2025.12.013","DOIUrl":"10.1016/j.jgar.2025.12.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Although the non-inferiority of adjunctive linezolid (LZD) was indicated for the treatment of invasive group A streptococcal (iGAS) infection, compared with adjunctive clindamycin (CLDM), additional evaluation of comparative effectiveness by subpopulation may further strengthen the evidence. We compared the efficacy of CLDM and LZD combination therapy for iGAS infection.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, data were extracted and analysed using TriNetX, a multicentre database. Data were extracted from 1 January 2015 to 30 April 2025, creating two cohorts (adjunctive CLDM and LZD groups). The primary endpoint was mortality within 90 d from diagnosis, which was compared between groups using propensity score matching. Subgroup analyses were conducted according to age, concomitant intravenous immunoglobulin treatment, and study period.</div></div><div><h3>Results</h3><div>For analysis, 5841 cases were identified in the CLDM combination group and 1426 in the LZD group. The primary endpoint was observed in 170 (12.0%) cases in the CLDM group and 195 (13.8%) in the LZD group. Odds ratio was 0.854 (95% confidence interval 0.685–1.065, <em>P</em> = 0.161), with odds ratio &lt;1 indicating a CLDM-favourable result.</div></div><div><h3>Conclusions</h3><div>Clinical efficacy of adjunctive CLDM and LZD was compared in patients with iGAS infection. No significant difference in mortality was observed in the overall population. LZD may be a potential alternative in cases where CLDM use is limited by resistance, intolerance, or contraindications.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 241-245"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New NDM-producing and blaKPC-2 harbouring Klebsiella pneumoniae ST6668 (CC147) clone in Milan, Northern Italy","authors":"Sara Giordana Rimoldi ,&nbsp;Francesco Comandatore ,&nbsp;Chiara Cogliati ,&nbsp;Stefano Odelli ,&nbsp;Loriana Morelli ,&nbsp;Pierachille Santus ,&nbsp;Spinello Antinori ,&nbsp;Alberto Dolci","doi":"10.1016/j.jgar.2025.11.016","DOIUrl":"10.1016/j.jgar.2025.11.016","url":null,"abstract":"","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 126-127"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clonal diversity and plasmid-mediated emergence of NDM-1-producing Raoultella ornithinolytica in clinical isolates","authors":"Jin Seok Kim ,&nbsp;Young Hee Jin ,&nbsp;So Youn Park ,&nbsp;Hyo-Won Jeong ,&nbsp;Jinwoo Kim ,&nbsp;Sook Hyun Park ,&nbsp;Chang-Kyu Kim ,&nbsp;YoungAh Yoo ,&nbsp;Young Kyung Yoon ,&nbsp;Jae In Lee ,&nbsp;Jihun Jung ,&nbsp;Ju-Sung Park","doi":"10.1016/j.jgar.2025.11.018","DOIUrl":"10.1016/j.jgar.2025.11.018","url":null,"abstract":"<div><h3>Objective</h3><div><em>Raoultella ornithinolytica</em> is recognized as an emerging opportunistic pathogen, with sporadic reports of multidrug resistance. However, comprehensive analyses of carbapenem-resistant isolates remain limited. This study investigated the molecular features and plasmid-mediated transmission of <em>bla</em>_NDM-1 among clonally distinct clinical isolates of <em>R. ornithinolytica</em> in Seoul, South Korea.</div></div><div><h3>Methods</h3><div>All 13 carbapenem-resistant <em>R. ornithinolytica</em> isolates referred to the central reference laboratory in Seoul from seven hospitals between 2018 and 2020 were analysed. Isolates were characterized using antimicrobial susceptibility testing, resistance gene detection, plasmid replicon typing, pulsed-field gel electrophoresis, conjugation assays, and whole-genome sequencing.</div></div><div><h3>Results</h3><div>Among the 13 isolates, 10 harboured <em>bla</em>_NDM-1, seven of which carried the gene on IncX3 plasmids. Despite clonal diversity, six of the 13 isolates shared nearly identical transferable IncX3 plasmids of approximately 45 kb, indicating horizontal plasmid dissemination among non-clonal strains. A novel <em>bla</em>_NDM-1 configuration, IS<em>3000</em>–∆IS<em>Aba125</em>–IS<em>1A</em>–<em>bla</em>_NDM-1–<em>ble</em>_MBL–<em>trpF</em>, was found in both <em>R. ornithinolytica</em> and <em>Enterobacter cloacae</em> from a single hospital, including two patients with co-infection. These findings highlighting the key role of IncX3 plasmids in rapid dissemination of <em>bla</em>_NDM-1 across species boundaries.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the contribution of IncX3 plasmids to the intra- and interspecies spread of <em>bla</em>_NDM-1, underscoring the need for enhanced genomic surveillance of emerging pathogens such as <em>R. ornithinolytica</em> to limit carbapenem resistance transmission in clinical settings.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 132-136"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The epidemiological and molecular characteristics and sulbactam-durlobactam susceptibility of carbapenem-resistant Acinetobacter baumannii in a Chinese teaching hospital","authors":"Hanlian Huang ,&nbsp;Qiaomin Zhang ,&nbsp;Shaobo Li ,&nbsp;Xiaoyan Dai,&nbsp;Zhongbiao Chen,&nbsp;Guili Zhang,&nbsp;Wen Ma,&nbsp;Hongwei Shen","doi":"10.1016/j.jgar.2025.12.003","DOIUrl":"10.1016/j.jgar.2025.12.003","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to investigate sulbactam-durlobactam (SUL-DUR) susceptibility and molecular features of carbapenem-resistant <em>Acinetobacter baumannii</em> (CRAB) isolates from a Shenzhen teaching hospital.</div></div><div><h3>Methods</h3><div>A retrospective study on CRAB was conducted from January 2018 to June 2025. Isolates were screened for <em>gyrB</em> and β-lactamase genes (<em>bla</em>OXA-23, −24, −51, and −58). Multi-locus sequence typing (MLST) was used for genotyping, and SUL-DUR susceptibility was tested by disk diffusion. The SUL-DUR-resistant isolate underwent whole-genome sequencing to identify resistance mechanisms.</div></div><div><h3>Results</h3><div>Of 741 non-duplicate <em>A. baumannii</em> isolates, 147 were CRAB, with its annual percentage rising from 11.4% (2018) to 47.2% (2025). Most isolates came from the ICU (53.7%), and affected patients were predominantly aged ≥60 years (62.6%). Sputum was the primary source (49.7%). Resistance rates exceeded 90% for multiple antibiotics, but only one isolate (0.7%) was resistant to SUL-DUR. This strain harbored nine resistance genes (including <em>bla</em>OXA-23 and <em>bla</em>OXA-66) and had substitutions in penicillin-binding protein 2 (PBP2) and a putative D-Ala-D-Ala carboxypeptidase.</div><div>Five sequence types (STs) were identified, including ST2, ST877, ST133, ST195, and a novel sequence type (ST3267), with ST2 being predominant (96.6%). The <em>bla</em>OXA-23 gene was present in 72.8% of isolates, while <em>bla</em>OXA-24 was rare (2.7%). All isolates carried intrinsic <em>bla</em>OXA-51 and <em>gyrB</em>, but <em>bla</em>OXA-58 was absent.</div></div><div><h3>Conclusions</h3><div>The increasing percentage of carbapenem-resistance among <em>A. baumannii</em>, dominated by ST2 and <em>bla</em>OXA-23-positive strains, highlights an urgent need for stricter infection control. Meanwhile, the notable <em>in vitro</em> susceptibility of CRAB to SUL-DUR offers a promising therapeutic alternative for patients infected with CRAB.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 137-145"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of antimicrobial prophylaxis in colorectal cancer surgery on the gut and oral microbiome and resistome: A prospective observational cohort study","authors":"Hiroki Kitagawa ,&nbsp;Toshiki Kajihara ,&nbsp;Koji Yahara ,&nbsp;Norikazu Kitamura ,&nbsp;Norifumi Shigemoto ,&nbsp;Hirofumi Doi ,&nbsp;Kensuke Shimbara ,&nbsp;Kosuke Yoshimura ,&nbsp;Ikki Nakashima ,&nbsp;Shinnosuke Uegami ,&nbsp;Yusuke Watadani ,&nbsp;Miki Kawada-Matsuo ,&nbsp;Hitoshi Komatsuzawa ,&nbsp;Hiroki Ohge ,&nbsp;Motoyuki Sugai","doi":"10.1016/j.jgar.2025.12.014","DOIUrl":"10.1016/j.jgar.2025.12.014","url":null,"abstract":"<div><h3>Background</h3><div>The use of antibiotics may facilitate the colonisation of antimicrobial-resistant organisms and genes within the host microbiome. However<strong>,</strong> studies on the effects of antibiotics on microbiomes and resistomes in clinical settings are limited.</div></div><div><h3>Aim</h3><div>The aim of this study was to determine the effects of antibiotic prophylaxis during colorectal cancer surgery on the oral and gut microbiomes and resistomes of patients.</div></div><div><h3>Methods</h3><div>We conducted a single-centre prospective observational cohort study on patients who underwent colorectal cancer surgery with antibiotic prophylaxis. DNA was extracted from oral and stool samples 1 day prior to the procedure and on postoperative days 1, 7, and 28. Subsequently, metagenomic sequencing was performed.</div></div><div><h3>Findings</h3><div>Among the eight patients with colorectal cancer, α-diversity in the oral and stool samples significantly decreased from baseline to each of the three post-administration time points. The abundance of anaerobic genera significantly decreased from baseline to Day 7. In the stool samples, <em>Enterococcus, Limosilactobacillus</em>, and <em>Lacticaseibacillus</em> abundances were markedly increased. Total antibiotic resistance gene (ARG) abundance significantly increased from the baseline to Day 7 in both oral and stool samples. The impact of the increase observed on Day 7 decreased but still persisted until Day 28 for diversity and total abundance of ARGs.</div></div><div><h3>Conclusions</h3><div>Oral and gut microbiomes and resistomes exhibited marked alterations that gradually reversed over time. Changes in the microbiome were associated with the spectrum of antibiotics used.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 227-234"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic burden of carbapenem-resistant Klebsiella pneumoniae infections in Chinese hospitals: A 2019 analysis","authors":"Jinjin Zhang ,&nbsp;Ruyin Zhou ,&nbsp;Jingru Ren ,&nbsp;Ziping Wu ,&nbsp;Jianzhong Shen ,&nbsp;Yang Wang ,&nbsp;Shenggen Fan ,&nbsp;Xiangming Fang","doi":"10.1016/j.jgar.2025.11.006","DOIUrl":"10.1016/j.jgar.2025.11.006","url":null,"abstract":"<div><h3>Background</h3><div>The resistance rate of carbapenem-resistant <em>Klebsiella pneumoniae</em> (CRKP) resistance rate has risen by 20% over the past 19 y in China. The socioeconomic burden of CRKP infections has rarely been estimated.</div></div><div><h3>Methods</h3><div>We estimated the number of CRKP-infected inpatients, the disability-adjusted life-years lost, and the socioeconomic burden in China in 2019. Using national surveillance data (China Antimicrobial Surveillance System), published literature, and official statistics, we adapted Cassini’s disease progression model to the Chinese context to quantify the clinical and economic impact. Sensitivity analyses were adjusted for retirement age and age-specific mortality.</div></div><div><h3>Results</h3><div>In 2019, an estimated 263 000 inpatients had CRKP infections, resulting in 0.72 million disability-adjusted life-years lost (2.73 per patient). Direct medical costs reached $0.61 billion, indirect costs $3.85 billion, totalling $4.46 billion (0.03% of 2019 GDP). Median annual cost per patient was $16 940.</div></div><div><h3>Conclusions</h3><div>CRKP infections impose significant health and economic burden on China. Enhanced infection control, antimicrobial stewardship, and investment in rapid diagnostics and novel therapeutics are urgently needed. The methodology used in this study can also support burden assessments for other resistant pathogens in similar contexts.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 63-70"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of the cfr gene and co-dissemination with the fosD gene in swine-derived Staphylococcus aureus","authors":"Wei Li ,&nbsp;Wenguang Xiong ,&nbsp;Junzhuo Guo ,&nbsp;Na Sun ,&nbsp;Zhenling Zeng","doi":"10.1016/j.jgar.2025.11.009","DOIUrl":"10.1016/j.jgar.2025.11.009","url":null,"abstract":"<div><h3>Objective</h3><div>Animal-derived <em>Staphylococcus aureus</em> frequently exhibits multidrug resistance, with complex and diverse resistance mechanisms that have raised significant public health concerns. The objective of this study was to determine the prevalence of <em>S. aureus</em> in swine farms and evaluate its antimicrobial resistance and distribution of oxazolidinone resistance genes.</div></div><div><h3>Methods</h3><div>The swine samples were collected on 17 swine farms from four provinces in China. All <em>S. aureus</em> isolates were screened for <em>cfr, optrA</em>, and <em>poxtA</em>. Whole-genome sequencing of <em>cfr</em>-positive strains revealed their molecular characteristics. All <em>cfr</em>-positive isolates were subjected to antimicrobial susceptibility testing.</div></div><div><h3>Results</h3><div>A total of 302 swine-derived <em>S. aureus</em> were collected from 4973 samples. Seven <em>cfr</em>-positive <em>S. aureus</em> strains, including four ST1-t4792 MSSA, two ST9-t4358 MSSA, and one ST398-t034 MRSA, were identified by whole-genome sequencing. Antimicrobial susceptibility testing against 23 agents from 12 classes revealed that all <em>cfr</em>-positive strains were resistant to penicillin, ampicillin, erythromycin, tetracycline, doxycycline, clindamycin, florfenicol, tiamulin, and valnemulin. Six MSSA strains additionally exhibited resistance to gentamicin, kanamycin, and ciprofloxacin, while three strains showed resistance to tilmicosin, ciprofloxacin, and trimethoprim-sulfamethoxazole. Third-generation sequencing of a strain co-harbouring <em>cfr</em> and <em>fosD</em> demonstrated that both genes were located on a plasmid also carrying <em>fexA</em> and <em>aadD</em>.</div></div><div><h3>Conclusions</h3><div>This study revealed the presence of the <em>cfr</em> gene across diverse multilocus sequence typing types of <em>S. aureus</em> and highlighted the co-dissemination of <em>cfr</em> with <em>fosD</em> and other resistance genes via plasmids in <em>S. aureus</em>. Based on One Health principles and risk of multidrug resistance spread, continuous surveillance of animal-derived <em>S. aureus</em> was urgently needed.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 57-62"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undetected rifampicin-resistant tuberculosis associated with rpoB I491F and V170F mutations in Botswana: Diagnostic implications","authors":"Tuelo Mogashoa ,&nbsp;Justice T. Ngom ,&nbsp;Johannes Loubser ,&nbsp;Kedumetse Seru ,&nbsp;Tuduetso Molefi ,&nbsp;One Stephen ,&nbsp;Rosemary M. Musonda ,&nbsp;Simani Gaseitsiwe ,&nbsp;Robin M. Warren ,&nbsp;Anzaan Dippenaar ,&nbsp;Elizabeth M. Streicher ,&nbsp;Sikhulile Moyo","doi":"10.1016/j.jgar.2025.12.005","DOIUrl":"10.1016/j.jgar.2025.12.005","url":null,"abstract":"<div><h3>Background</h3><div>Undetected rifampicin resistance is a threat to global tuberculosis (TB) control efforts by delaying effective treatment. In different studies, non-canonical <em>rpoB</em> mutations outside the rifampicin resistance-determining region have been reported at varying prevalences by country. Here, we report cases of rifampicin resistance in Botswana that were missed by the routine molecular diagnostic assays.</div></div><div><h3>Methods</h3><div>Individuals were tested under routine programme conditions, in accordance with national guidelines, at four designated drug-resistant TB clinics from 2017 to 2022. Initial testing at the facilities included GeneXpert MTB/RIF ultra and later phenotypic drug susceptibility testing (pDST), as well as the Hain MTBDR<em>sl</em> line probe assay, at the National Tuberculosis Reference Laboratory. A total of nine isolates were subsequently sequenced on the Illumina NextSeq 2000 instrument.</div></div><div><h3>Results</h3><div>At the point of care, routine molecular tests classified all nine individuals as susceptible to rifampicin. Subsequent culture and phenotypic drug susceptibility testing confirmed rifampicin resistance. Whole-genome sequencing identified non-canonical <em>rpoB</em> mutations outside the rifampicin resistance-determining region I49F and V170F, which are associated with low-level rifampicin resistance. Of the nine isolates sequenced, 4 (44%) harboured the <em>rpoB</em> V170F mutation, while 5 (56%) harboured the <em>rpoB</em> I491F mutation.</div></div><div><h3>Conclusions</h3><div>These results highlight a diagnostic gap within the current algorithms and show the value of sequencing-based approaches for accurately detecting drug resistance. Incorporating sequencing into routine clinical practice could help guide the selection of TB treatment and improve treatment outcomes in patients who do not respond to first-line therapy.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 171-174"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145756899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}