Weibin Li

Background: Antimicrobial resistance (AMR) is an escalating global health crisis being worsened by climate change. Studies of temperature–AMR associations remain limited by geographic scope, time frames and linear approaches. We aimed to identify temperature thresholds where AMR dynamics shift across pathogen–drug combinations, periods and socioeconomic contexts. Methods: We analysed data from 56 countries and territories over 24 years (1999–2022), focusing on six WHO-designated ‘critical’ antibiotic-resistant pathogens. Using segmented regression models with mean ambient temperature as the primary independent variable, we divided the study period into three intervals (1999–2006, 2007–2014, 2015–2022) and incorporated 16 socioeconomic and environmental covariates. Model robustness was validated through bootstrap cross-validation with 1000 resamples. Findings: We identified distinct temperature association thresholds for each pathogen–drug combination (5.7°C–18.4°C). Below these thresholds, resistance rates consistently decreased with rising temperatures; above thresholds, responses varied by phenotype and time period. For third-generation cephalosporin-resistant Escherichia coli , each 1°C rise above 16.5°C corresponded to a 0.46% increase (95% CI 0.28% to 0.65%; pAcinetobacter baumannii ( β =−1.40, p<0.001). Interpretation: Phenotype-specific temperature association thresholds provide descriptive, hypothesis-generating reference points for understanding how AMR burden varies along the global temperature gradient. The observed temporal heterogeneity suggests complex patterns requiring long-term monitoring and climate-adaptive AMR control strategies considering both phenotype-specific temperature sensitivities and socioeconomic contexts.

Climate change poses substantial challenges in containing antimicrobial resistance (AMR) from a One Health perspective. Using 4,502 AMR surveillance records involving 32 million tested isolates from 101 countries (1999–2022), we analyzed the impact of socioeconomic and environmental factors on AMR. We also established forecast models based on several scenarios, considering antimicrobial consumption reduction, sustainable development initiatives and different shared socioeconomic pathways under climate change. Our findings reveal growing AMR disparities between high-income countries and low- and middle-income countries under different shared socioeconomic pathway scenarios. By 2050, compared with the baseline, sustainable development efforts showed the most prominent effect by reducing AMR prevalence by 5.1% (95% confidence interval (CI): 0.0–26.6%), surpassing the effect of antimicrobial consumption reduction. Key contributors include reducing out-of-pocket health expenses (3.6% (95% CI: −0.5 to 21.4%)); comprehensive immunization coverage (1.2% (95% CI: −0.1% to 8.2%)); adequate health investments (0.2% (95% CI: 0.0–2.4%)) and universal access to water, sanitation and hygiene services (0.1% (95% CI: 0.0–0.4%)). These findings highlight the importance of sustainable development strategies as the most effective approach to help low- and middle-income countries address the dual challenges of climate change and AMR.

Background: To investigate the epidemiological characteristics and resistance changes of carbapenem-resistant organisms (CROs) under the COVID-19 outbreak to provide evidence for precise prevention and control measures against hospital-acquired infections during the pandemic. Methods: The distribution characteristics of CROs (i.e., carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii) were analyzed by collecting the results of the antibiotic susceptibility tests of diagnostic isolates from all patients. Using interrupted time series analysis, we applied Poisson and linear segmented regression models to evaluate the effects of COVID-19 on the numbers and drug resistance of CROs. We also conducted a stratified analysis using the Cochran–Mantel–Haenszel test. Results: The resistance rate of carbapenem-resistant Acinetobacter baumannii (CRAB) was 38.73% higher after the COVID-19 outbreak compared with before (p < 0.05). In addition, the long-term effect indicated that the prevalence of CRAB had a decreasing trend (p < 0.05). However, the overall resistance rate of Klebsiella pneumoniae did not significantly change after the COVID-19 outbreak. Stratified analysis revealed that the carbapenem-resistant Klebsiella pneumoniae (CRKP) rate increased in females (OR = 1.98, p < 0.05), those over 65 years old (OR = 1.49, p < 0.05), those with sputum samples (OR = 1.40, p < 0.05), and those in the neurology group (OR = 2.14, p < 0.05). Conclusion: The COVID-19 pandemic has affected the change in nosocomial infections and resistance rates in CROs, highlighting the need for hospitals to closely monitor CROs, especially in high-risk populations and clinical departments. It is possible that lower adherence to infection control in crowded wards and staffing shortages may have contributed to this trend during the COVID-19 pandemic, which warrants further research.