Lancet Regional Health-Europe最新文献

{"title":"A call to action to address the steatotic liver disease public health threat in Barcelona","authors":"Jeffrey V. Lazarus ,&nbsp;J. Emilio Miralles-Sanchez ,&nbsp;Leire Agirre-Garrido ,&nbsp;Nicolai Brachowicz ,&nbsp;Aina Nicolàs ,&nbsp;Anthony Armenta Jr. ,&nbsp;Delfina Boudou ,&nbsp;Lisa Rice-Duek ,&nbsp;Juan M. Pericàs ,&nbsp;Joan Benach ,&nbsp;Christopher J. Kopka ,&nbsp;Dana Ivancovsky Wajcman","doi":"10.1016/j.lanepe.2025.101272","DOIUrl":"10.1016/j.lanepe.2025.101272","url":null,"abstract":"<div><div>Despite their high prevalence worldwide, steatotic liver diseases (SLDs) are largely excluded from most non-communicable disease (NCD) guidelines and strategies. We propose policies and strategies to achieve the United Nations Sustainable Development Goal of reducing NCD premature mortality by one-third by 2030. To assess this gap—the exclusion of SLDs from NCD policies—in urban areas, we reviewed Barcelona’s strategies for NCD risks (e.g., alcohol, tobacco, healthy food access). We then explored applications of geo-spatial visualisation and whole-of-society approaches (e.g., citizen science engagement) aligned with the World Health Organization (WHO) Best Buys to provide recommendations to address NCDs, generally, and SLDs specifically.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"52 ","pages":"Article 101272"},"PeriodicalIF":13.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal and neonatal outcomes of pregnancies after metabolic bariatric surgery: a retrospective population-based study","authors":"Pierre Bel Lassen ,&nbsp;Anne-Isabelle Tropeano ,&nbsp;Armelle Arnoux ,&nbsp;Estelle Lu ,&nbsp;Louis Romengas ,&nbsp;Sandrine Katsahian ,&nbsp;Bérénice Ségrestin ,&nbsp;Bénédicte Lelièvre ,&nbsp;Delphine Mitanchez ,&nbsp;Géraldine Gascoin ,&nbsp;Tigran Poghosyan ,&nbsp;Andrea Lazzati ,&nbsp;Barbara Heude ,&nbsp;Jacky Nizard ,&nbsp;Sébastien Czernichow ,&nbsp;Cécile Ciangura ,&nbsp;Claire Rives-Lange","doi":"10.1016/j.lanepe.2025.101263","DOIUrl":"10.1016/j.lanepe.2025.101263","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The incidence of post metabolic bariatric surgery (BS) pregnancies is rising. Previous studies provided conflicting results regarding the risk of prematurity, stillbirth, perinatal death and the optimal time from BS to conception. This study examined maternal and neonatal outcomes of post-BS pregnancies and influencing factors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Nationwide retrospective study of all post-BS pregnancies in France from January 1st 2013 to December 31st 2022. We compared 55,941 post-BS pregnancies with 223,712 controls matched on delivery date, parity, age, obesity, hypertension, diabetes, and socio-economic status (1:4 ratio) using generalized estimating equations. We also compared 11,777 post-BS pregnancies with 11,777 pre-BS pregnancies in the same women, using conditional logistic regression. Maternal outcomes included gestational hypertension, preeclampsia, and gestational diabetes. Neonatal outcomes included small-for-gestational-age (SGA), prematurity, stillbirth, and perinatal death. We tested for interactions with BS type, BS to pregnancy time interval and malnutrition.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Post-BS pregnancies were associated with reduced risk of gestational hypertension (odds ratio [OR] 0.57 [95% CI 0.53–0.62]), preeclampsia (OR 0.59 [0.55–0.64]), and gestational diabetes (OR 0.64 [0.62–0.66]) as compared with control. Similar but stronger risk reductions were observed compared with pre-BS pregnancies. Risk of SGA was increased (OR 1.74 [1.68–1.79]) as compared with controls and pre-BS pregnancies (OR 1.88 [1.64–2.16]). Risk of prematurity was increased (OR 1.27 [1.22–1.31]) as compared with controls but not pre-BS pregnancies (OR 0.95 [0.85–1.06]). Compared with controls, risk of stillbirth was increased (OR 1.2 [1.06–1.35]), mediated by SGA, as was perinatal death (OR 1.5 [1.13–1.99]), mediated by both prematurity and SGA. Increased SGA risk compared to controls was higher with malnutrition (OR: 2.38 [1.96, 2.88], p&lt;sub&gt;interaction&lt;/sub&gt; &lt;0.0001), with &lt;6 months (OR: 1.95 [1.72, 2.21], p&lt;sub&gt;interaction&lt;/sub&gt; = 0.01) or 6–12 months between BS and pregnancy (OR: 1.86 [1.70, 2.04], p&lt;sub&gt;interaction&lt;/sub&gt; = 0.02) and with gastric bypass (OR: 1.88 [1.77–2.00], p&lt;sub&gt;interaction&lt;/sub&gt; = 0.027). Increased prematurity risk compared to controls was higher with malnutrition (2.45 [1.99, 3.00], p&lt;sub&gt;interaction&lt;/sub&gt; &lt;0.0001) and gastric bypass (OR: 1.46 [1.36–1.57], p&lt;sub&gt;interaction&lt;/sub&gt; = 0.0003).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Post-BS compared with pre-BS or control pregnancies were associated with reduced risk of maternal adverse outcomes but increased risk of neonatal adverse events. The risks of SGA and prematurity are higher with shorter intervals between BS and conception, gastric bypass, and malnutrition. Post-BS pregnancies could be considered high risk, requiring close nutritional and obstetrical monitoring.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;Su","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"51 ","pages":"Article 101263"},"PeriodicalIF":13.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New opportunities for accessing promising non-oncological orphan drugs","authors":"Carla E.M. Hollak ,&nbsp;Carelle C. Reparon-Schuijt ,&nbsp;Kathelijn Verdeyen ,&nbsp;Lisa J. Deesker ,&nbsp;Jaap W. Groothoff ,&nbsp;Josephine M.I. Vos ,&nbsp;Atse H. Huisman ,&nbsp;Silvia van der Flier ,&nbsp;Anke A.M.G. Pisters-van Roy","doi":"10.1016/j.lanepe.2025.101275","DOIUrl":"10.1016/j.lanepe.2025.101275","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"52 ","pages":"Article 101275"},"PeriodicalIF":13.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PCR and biomarker algorithms to guide antibiotics in lower respiratory tract infections—is the future now?","authors":"Werner C. Albrich ,&nbsp;Noémie Boillat-Blanco","doi":"10.1016/j.lanepe.2025.101277","DOIUrl":"10.1016/j.lanepe.2025.101277","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"51 ","pages":"Article 101277"},"PeriodicalIF":13.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic bariatric surgery and pregnancy: balancing maternal benefits with neonatal risks","authors":"Antonio Iannelli ,&nbsp;Sergio Carandina","doi":"10.1016/j.lanepe.2025.101280","DOIUrl":"10.1016/j.lanepe.2025.101280","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"51 ","pages":"Article 101280"},"PeriodicalIF":13.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalisations for physical abuse in infants and children less than 5 years, 2013–2021: a multinational cohort study using administrative data from five European countries","authors":"Catherine Quantin ,&nbsp;Jonathan Cottenet ,&nbsp;Colleen Chambers ,&nbsp;Natasha Kennedy ,&nbsp;Sadhbh Whelan ,&nbsp;Geoff Debelle ,&nbsp;Diogo Lamela ,&nbsp;Ulugbek Nurmatov ,&nbsp;Donna O'Leary ,&nbsp;Christian Torp-Pedersen ,&nbsp;Sinéad Brophy ,&nbsp;Marcella Broccia ,&nbsp;Ruth Gilbert ,&nbsp;Troels Græsholt-Knudsen ,&nbsp;Laura Elizabeth Cowley","doi":"10.1016/j.lanepe.2025.101270","DOIUrl":"10.1016/j.lanepe.2025.101270","url":null,"abstract":"<div><h3>Background</h3><div>Child physical abuse (CPA) is a global public health problem associated with lifelong negative consequences, yet reliable epidemiologic data are lacking. This multinational cohort study analyses trends in CPA hospitalisations from 2013 to 2021.</div></div><div><h3>Methods</h3><div>We used medico-administrative databases to identify children aged one month to five years hospitalised in Denmark, England, France, Ireland, and Wales. We identified CPA using a validated algorithm based on ICD-10 codes. We calculated the number, proportion, and incidence rate of children hospitalised for CPA, and the number and proportion of total hospitalisations for CPA, by year and age group (&lt;1 and &lt;5). We determined the proportion of CPA hospitalisations recorded using different ICD-10 codes, by country.</div></div><div><h3>Findings</h3><div>The pooled incidence rate of infants &lt;1 year hospitalised for CPA was stable over time (around 42/100,000 per year), ranging on average from 33 to 48/100,000 between countries. The pooled proportion of infant hospitalisations for CPA was around 0.17% (N = 750) per year (range 0.15–0.21%, N range 674–785), increasing significantly during the COVID-19 pandemic in 2020 (0.21%, N = 674). In children &lt;5, the incidence rate (around 18/100,000 per year) and proportion of CPA hospitalisations (around 0.11% per year (N = 1600), range 0.10–0.14% (N range 1341–1657) were lower than in infants, but also increased in 2020 (0.14%, N = 1341). There were national differences in the distribution of ICD-10 codes used to record CPA and differences in year-on-year trends between countries.</div></div><div><h3>Interpretation</h3><div>Comparing temporal trends in CPA hospitalisations between countries is feasible. Hospital data are one of several valuable sources for CPA surveillance.</div></div><div><h3>Funding</h3><div>European COST Action EURO-CAN. <span>European Union</span> (HORIZON Europe SERENA project).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"52 ","pages":"Article 101270"},"PeriodicalIF":13.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic inequalities in diagnostics, care and survival outcomes for hepatocellular carcinoma in Sweden: a nationwide cohort study","authors":"Juan Vaz ,&nbsp;Hannes Hagström ,&nbsp;Malin Sternby Eilard ,&nbsp;Magnus Rizell ,&nbsp;Ulf Strömberg","doi":"10.1016/j.lanepe.2025.101273","DOIUrl":"10.1016/j.lanepe.2025.101273","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. This study evaluates how strongly socioeconomic factors associate with diagnostics, treatment, and survival among patients with HCC in Sweden.</div></div><div><h3>Methods</h3><div>All adult patients registered with a diagnosis of HCC in the Swedish quality register for liver cancer between 2011 and 2021 were included. Household income was classified as low (first quartile; poorest), medium (second or third quartile), or high (in fourth quartile; wealthiest) based on the overall distribution of household income across all household in Sweden. Outcomes included likelihood of diagnosis under surveillance, early-stage diagnosis (Barcelona Clinic Liver Cancer [BCLC] staging 0-A), and receipt of curative treatment (ablation, resection or liver transplantation), as well as mortality risk.</div></div><div><h3>Findings</h3><div>Among 5490 patients, a significant association was found between low household income and decreased likelihood of diagnosis while under surveillance (adjusted odds ratio [aOR] 0·63; 95% confidence interval [CI]: 0·50–0·80), early-stage diagnosis (aOR 0·58; 95% CI: 0·51–0·67), and curative treatment receipt (aOR 0·65; 95% CI: 0·50–0·85). After adjustments for all variables in the BCLC, other sociodemographic variables, comorbidities, and cirrhosis status, patients with low household income had an adjusted hazard ratio for mortality of 1·29 (95% CI: 1·15–1·45) compared to patients with high household income.</div></div><div><h3>Interpretation</h3><div>Socioeconomic disparities associate markedly with more advanced stage at HCC diagnosis, less curative treatment, and poorer survival in Sweden. Addressing these disparities through targeted public health interventions may improve HCC care and outcomes in socioeconomically disadvantaged populations.</div></div><div><h3>Funding</h3><div>The <span>Swedish Cancer Society</span>—<span>Cancerfonden</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"52 ","pages":"Article 101273"},"PeriodicalIF":13.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific associations between sleep apnoea and lung cancer risk in patients with COPD: a nationwide prospective cohort study","authors":"Kristiaan Proesmans ,&nbsp;Annemarie I. Luik ,&nbsp;Lies Lahousse","doi":"10.1016/j.lanepe.2025.101269","DOIUrl":"10.1016/j.lanepe.2025.101269","url":null,"abstract":"<div><h3>Background</h3><div>COPD is an established risk factor for lung cancer. Sleep apnoea is prevalent in COPD and the inflammation caused by intermittent hypoxaemia may increase this lung cancer risk. Females have more systemic inflammation for a similar apnoea-hypopnoea index than males. Therefore, this study aims to investigate sex-specific associations between sleep apnoea and lung cancer in COPD.</div></div><div><h3>Methods</h3><div>The sex-specific absolute and relative risk of sleep apnoea on newly diagnosed lung cancer was estimated in a nationwide observational study of Belgian patients with COPD (≥55 years), between 2017 and 2022, using an Aalan-Johanson estimator and a cause-specific Cox regression model adjusted for age, socioeconomic status, smoking status, alcoholism, frailty, comorbidities, and comedication.</div></div><div><h3>Findings</h3><div>The study consisted of 62,903 COPD patients (42·80% female), of whom 2898 (4·60%) developed lung cancer. We found a significant sex interaction of sleep apnoea on lung cancer hazard (<strong><em>χ</em></strong>-squared: 13·239, P-interaction &lt; 0·01). In females, sleep apnoea was associated with a higher lung cancer risk (cumulative incidence: 1545 vs 1350 per 100,000 PY; aHR: 1·31 (95% CI: 1·05–1·63)). For males, sleep apnoea patients had a lower lung cancer risk (cumulative incidence: 1632 and 2305 per 100,000 PY; aHR: 0·82 (95% CI: 0·70–0·95)). The impact of sleep apnoea on lung cancer development was especially strong in female COPD patients with hypoxia-related comorbidities e.g., with a history of emphysema (aHR: 2·65 (95% CI: 1·11–6·34)).</div></div><div><h3>Interpretation</h3><div>Sleep apnoea was associated with a higher risk of lung cancer in female COPD patients while, in males, there was a lower risk. Especially in female COPD patients with hypoxia, sleep apnoea is strongly associated with an increased lung cancer risk.</div></div><div><h3>Funding</h3><div>Emmanuel van der Schueren cancer research fellowship “<span>Kom Op Tegen Kanker</span>”.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"52 ","pages":"Article 101269"},"PeriodicalIF":13.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence rate of infective endocarditis by socioeconomic position: a Danish nationwide cohort study (2000–2022)","authors":"Søren K. Martiny ,&nbsp;Morten Schmidt ,&nbsp;Jonas A. Povlsen ,&nbsp;Kirstine K. Søgaard ,&nbsp;Hans E. Bøtker ,&nbsp;Henrik T. Sørensen","doi":"10.1016/j.lanepe.2025.101267","DOIUrl":"10.1016/j.lanepe.2025.101267","url":null,"abstract":"<div><h3>Background</h3><div>People with lower socioeconomic positions have a higher risk of cardiac and infectious diseases than those with higher socioeconomic positions. However, how the increasing incidence of infective endocarditis among different socioeconomic groups has played out remains unclear. We therefore aimed to investigate nationwide temporal trends in infective endocarditis incidence rate by socioeconomic position in Denmark.</div></div><div><h3>Methods</h3><div>Using nationwide Danish registries, we investigated infective endocarditis incidence rate (2000–2022). As socioeconomic position indicator, we used affluence level (accounting for household-level income and wealth), dividing the population into low, medium, and high affluence. Average annual percentage changes were computed to evaluate temporal trends. Slope index and relative index of inequality were calculated to obtain inequality gradients.</div></div><div><h3>Findings</h3><div>Per 100,000 person-years, the incidence rate increased from 8.7 in 2000 to 21.2 in 2022 among low; from 7.4 to 14.3 among medium; and from 6.2 to 13.1 among high affluence people. The average annual percentage change was 4.3% among low, 3.5% among medium, and 3.7% among high affluence people. The slope index of inequality increased from 3.8 additional cases per 100,000 person years (95% CI: 0.4–7.3) in 2000 to 12.3 (95% CI: 7.4–17.1) in 2022. The relative index of inequality increased from 1.68 (95% CI: 0.90–2.44) to 2.13 (95% CI: 1.49–2.78).</div></div><div><h3>Interpretation</h3><div>The infective endocarditis incidence rates increased in all affluence levels, with highest rates consistently found in the lowest affluence group, indicating that people with lower socioeconomic positions faced a disproportionately higher risk of infective endocarditis. These findings highlight the need to consider socioeconomic factors when addressing modifiable determinants that may curb the rise in infective endocarditis incidence.</div></div><div><h3>Funding</h3><div><span>Independent Research Fund Denmark</span> (grant no. <span><span>3101-00102B</span></span>) and <span>Center for Population Medicine</span>, <span>Department of Clinical Epidemiology</span>, <span>Aarhus University</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"52 ","pages":"Article 101267"},"PeriodicalIF":13.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine: an observational study","authors":"Scott J.C. Pallett ,&nbsp;Anna Morkowska ,&nbsp;Stephen D. Woolley ,&nbsp;Viktoria V. Potochilova ,&nbsp;Kateryna L. Rudnieva ,&nbsp;Olga S. Iungin ,&nbsp;Vincenzo Sgro ,&nbsp;Sara E. Boyd ,&nbsp;Nicola Reece ,&nbsp;Zoe L. Lambert ,&nbsp;Ngee Keong Tan ,&nbsp;Nabeela Mughal ,&nbsp;Olena V. Moshynets ,&nbsp;Luke S.P. Moore ,&nbsp;Matthew K. O'Shea","doi":"10.1016/j.lanepe.2025.101274","DOIUrl":"10.1016/j.lanepe.2025.101274","url":null,"abstract":"<div><h3>Background</h3><div>Conflict can have devastating effects on the development and spread of antimicrobial resistance. In Ukraine, early data post-injury are limited. We aim to explore extensively drug-resistant (XDR) Gram negative phenotypes and genotypes for infections arising early following conflict-associated wounds in Ukraine.</div></div><div><h3>Methods</h3><div>Carbapenem-resistant infections following conflict-associated wounds in Ukraine (February–May 2024) underwent extended antimicrobial susceptibility testing (AST) for 19 antimicrobial agents using 2025 European Committee for Antimicrobial Susceptibility Testing breakpoints. Carbapenemase genes were identified using a novel multiplex molecular resistance assay. Infections arising in the first seven days versus those arising after seven days since injury were compared by logistic regression. Significance was set at <em>p</em> &lt; 0.05.</div></div><div><h3>Findings</h3><div>100 isolates were tested (53, 53.0% <em>Klebsiella pneumoniae</em>; 16, 16.0% <em>other</em> Enterobacterales; 18, 18.0% <em>Acinetobacter baumanii</em> and 13; 13.0% <em>Pseudomonas aeruginosa</em>). Gentamicin (<em>p</em> = 0.0046) and colistin (<em>p</em> = 0.049) resistance were higher in infections arising later. Overall, resistance rates for amikacin (74/100, 74.0%), cefiderocol (44/100, 44.0%) and ceftazidime-avibactam (26/79, 67.1%) were observed. Prevalent resistance genes included NDM + OXA-48-like (24/100, 24.0%), NDM-only (24/100, 24.0%) and KPC (9/100, 9%). Others included OXA 23-like/51-like, IMP and/or mcr1. Earlier infection isolates had a higher burden of carbapenemases/isolate (<em>p</em> = 0.006).</div></div><div><h3>Interpretation</h3><div>Extensively drug-resistant infections were observed early post-injury in Ukraine, with some trend to further resistance in those arising later in the patient pathway. A diverse presence of carbapenemase genes amid XDR Gram negative phenotypes highlights the importance of early screening for mechanisms of resistance in this setting.</div></div><div><h3>Funding</h3><div>This study was funded by the <span>Healthcare Infection Society</span> and <span>CW+ Charity</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"52 ","pages":"Article 101274"},"PeriodicalIF":13.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}