{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:24:56Z","timestamp":1793039096779,"version":"4.5.0"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n Escherichia coli<\/jats:italic>\n and\n Klebsiella pneumoniae<\/jats:italic>\n are major causes of urinary tract infections. While antibiotic resistance in these critical pathogens is a global concern, data from Africa remain sparse, cover short time frames, and aggregate multiple specimen types.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To model antimicrobial resistance trends in urinary\n E coli<\/jats:italic>\n and\n K pneumoniae<\/jats:italic>\n isolates from 6 African countries between 2010 and 2022 and to project future resistance patterns.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n Data for this retrospective cross-sectional study were obtained from Pasteur Network clinical laboratories located in the capital cities of 5 African countries (Cameroon, Central African Republic [CAR], Madagascar, Morocco, and Senegal) and from 1 university hospital in Benin. Urine samples yielding\n E coli<\/jats:italic>\n or\n K pneumoniae<\/jats:italic>\n collected during routine clinical care were included. Data collection spanned 2008 to 2023, with a shared observation period from October 2014 to December 2021. Data were analyzed from March through December 2025.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The primary outcome was resistance in\n E coli<\/jats:italic>\n and\n K pneumoniae<\/jats:italic>\n urinary isolates, measured as nonsusceptibility to aminopenicillins (for\n E coli<\/jats:italic>\n ), fluoroquinolones, third- and fourth-generation cephalosporins, \u03b2-lactam and \u03b2-lactamase inhibitor combinations, aminoglycosides, and carbapenems. Resistance trends were analyzed using logistic regression with generalized estimating equations.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 44\u202f367 urinary isolates (mean [SD] age of patients, 35.8 [30.2] years; 26\u202f935 isolates from women among 42\u202f839 samples with sex data [62.9%]) were included. Mean (SD) age ranged from 29.1 (30.5) years among patients with\n K pneumoniae<\/jats:italic>\n \u2013positive samples in Cameroon to 54.3 (23.4) years among patients with\n E coli<\/jats:italic>\n \u2013positive samples in Morocco.\n E coli<\/jats:italic>\n \u2013positive samples were more common in women, with the highest proportions in Madagascar (11\u202f948 women among 16\u202f137 patients [74.0%]) and CAR (1329 women among 1893 patients [70.2%]), whereas\n K pneumoniae<\/jats:italic>\n positive samples showed no clear sex pattern. At study end, amoxicillin resistance in\n E coli<\/jats:italic>\n exceeded 85% across sites (eg, 96.0% [95% CI, 93.5%-97.6%] in Morocco), and amoxicillin-clavulanate resistance surpassed 50% for\n E coli<\/jats:italic>\n (eg, 84.9% [95% CI, 77.7%-90.1%] in Morocco) and\n K pneumoniae<\/jats:italic>\n (eg, 96.1% [95% CI, 89.4%-98.7%] in Morocco) in most countries.\n E coli<\/jats:italic>\n resistance to third-generation cephalosporins (3GCs) and fluoroquinolones surpassed 35% at study end, with increasing trends in most countries (eg, 34.5% [95% CI, 27.3%-42.6%] to 59.8% [95% CI, 55.7%-63.8%] for cefotaxime in Benin and 32.4% [95% CI, 25.1%-40.7%] to 75.9% [95% CI, 72.4%-79.1%] for norfloxacin in Senegal). For\n K pneumoniae<\/jats:italic>\n , resistance to 3GCs increased in Cameroon, Madagascar, CAR, and Senegal, exceeding 50% in most settings (eg, 50.7% [95% CI, 45.6%-55.9%] to 76.6% [95% CI, 71.7%-80.9%] for cefotaxime in Madagascar). Rates remained stable in Benin and Morocco. Fluoroquinolone resistance increased in Cameroon, Senegal, and CAR (eg, 38.5% [95% CI, 25.7%-53.0%] to 65.8% [95% CI, 58.8%-72.2%] for ciprofloxacin in Senegal); remained high in Benin and Morocco; and decreased in Madagascar but remained elevated (eg, 63.7% [95% CI, 58.7%-68.3%] to 59.9% [95% CI, 54.1%-65.4%] for norfloxacin). For both bacteria, carbapenem resistance remained less than 18% (eg, 17.2% [95% CI, 11.8%-24.3%] for\n K pneumoniae<\/jats:italic>\n resistance to ertapenem in Senegal), but resistance to ertapenem reached 28.0% (95% CI, 25.7%-30.5%) for\n E coli<\/jats:italic>\n and 27.8% (95% CI, 22.0%-34.5%] for\n K pneumoniae<\/jats:italic>\n in Madagascar. Projections suggest that 3GC and carbapenem resistance could exceed 90% by 2050 in most countries (eg, 2037 [95% CI, 2032-2053] for\n E coli<\/jats:italic>\n resistance to imipenem in Benin).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this study, elevated and increasing resistance levels were observed, underlining the urgent need for improved measures against antimicrobial resistance in Africa.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.21865","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:00:20Z","timestamp":1783609220000},"page":"e2621865","source":"Crossref","is-referenced-by-count":3,"title":["Antimicrobial Resistance Trends in Urinary Tract Infections in 6 African Countries"],"prefix":"10.1001","volume":"9","author":[{"given":"Lala Fanomezantsoa","family":"Rafetrarivony","sequence":"first","affiliation":[{"name":"Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e9lix","family":"Cheysson","sequence":"additional","affiliation":[{"name":"Laboratoire d'Analyse et de Math\u00e9matiques Appliqu\u00e9es, Joint Research Unit 8050, French National Centre for Scientific Research, Gustave Eiffel University, Paris Est Creteil University, Marne-la-Vall\u00e9e, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dissou","family":"Affolabi","sequence":"additional","affiliation":[{"name":"Clinique Universitaire de Bact\u00e9riologie-Virologie, Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, B\u00e9nin"},{"name":"Laboratoire de R\u00e9f\u00e9rence des Mycobact\u00e9ries, Cotonou, B\u00e9nin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheikh","family":"Fall","sequence":"additional","affiliation":[{"name":"Pole Microbiologie, Institut Pasteur Dakar, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faridath","family":"Massou","sequence":"additional","affiliation":[{"name":"Clinique Universitaire de Bact\u00e9riologie-Virologie, Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, B\u00e9nin"},{"name":"Laboratoire de R\u00e9f\u00e9rence des Mycobact\u00e9ries, Cotonou, B\u00e9nin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaotar","family":"Nayme","sequence":"additional","affiliation":[{"name":"Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minone Rosanne","family":"Ngome","sequence":"additional","affiliation":[{"name":"Laboratoire Bact\u00e9riologie-Parasitologie-Mycologie, Centre Pasteur du Cameroun, Yaounde, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andriniaina","family":"Rakotondrasoa","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Bangui, Bangui, Central African Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Bovagnet","sequence":"additional","affiliation":[{"name":"Institut Pasteur-Data Management Core Facility, Paris, France"},{"name":"Infectious Diseases, Interactions and Antimicrobial Resistance Team, Centre de Recherche en \u00c9pid\u00e9miologie et Sant\u00e9 des Populations, Universit\u00e9 Paris-Saclay, Universit\u00e9 de Versailles Saint-Quentin-en-Yvelines, Inserm, Montigny-Le-Bretonneux, France"},{"name":"Epidemiology and Modelling of Antibacterial Evasion, Institut Pasteur, Universit\u00e9 Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aboubakr","family":"Khazaz","sequence":"additional","affiliation":[{"name":"Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco"},{"name":"Microbiology and Antimicrobial Agents Research Team, Laboratoire de Biotechnologie Vegetale, Ecologie et Valorisation Des Ecosystemes, Department of Biology, Faculty of Sciences, Chouaib Doukkali University, El Jadida, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugues","family":"Sanke-Wa\u00efgana","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Bangui, Bangui, Central African Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilles St\u00e9phane Landry","family":"Ngaya","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Bangui, Bangui, Central African Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Robert","family":"Mbecko","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Bangui, Bangui, Central African Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Lise","family":"Beaumont","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Interactions and Antimicrobial Resistance Team, Centre de Recherche en \u00c9pid\u00e9miologie et Sant\u00e9 des Populations, Universit\u00e9 Paris-Saclay, Universit\u00e9 de Versailles Saint-Quentin-en-Yvelines, Inserm, Montigny-Le-Bretonneux, France"},{"name":"Epidemiology and Modelling of Antibacterial Evasion, Institut Pasteur, Universit\u00e9 Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Crestani","sequence":"additional","affiliation":[{"name":"Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Universit\u00e9 Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yakhya","family":"Dieye","sequence":"additional","affiliation":[{"name":"Pole Microbiologie, Institut Pasteur Dakar, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babacar","family":"Ndiaye","sequence":"additional","affiliation":[{"name":"Laboratoire Biologie M\u00e9dicale, Institut Pasteur Dakar, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdou","family":"Diop","sequence":"additional","affiliation":[{"name":"Laboratoire Biologie M\u00e9dicale, Institut Pasteur Dakar, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierrette Landrie","family":"Simo Tchuinte","sequence":"additional","affiliation":[{"name":"Department of Hygiene and Environment Microbiology Section, Centre Pasteur of Cameroon, Yaounde, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariane","family":"Nzouankeu","sequence":"additional","affiliation":[{"name":"Department of Hygiene and Environment Microbiology Section, Centre Pasteur of Cameroon, Yaounde, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ars\u00e8ne Godlove","family":"Djoko Nono","sequence":"additional","affiliation":[{"name":"Department of Hygiene and Environment Microbiology Section, Centre Pasteur of Cameroon, Yaounde, Cameroon"},{"name":"Department of Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri","family":"Rasoloson","sequence":"additional","affiliation":[{"name":"Unit of Epidemiology and Clinical Research, Institut Pasteur de Madagascar, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9rique","family":"Randrianirina","sequence":"additional","affiliation":[{"name":"Clinical Biology Center, Institut Pasteur de Madagascar, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisoa Hariniaina","family":"Ratsima","sequence":"additional","affiliation":[{"name":"Clinical Biology Center, Institut Pasteur de Madagascar, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lovasoa","family":"Ramparany","sequence":"additional","affiliation":[{"name":"Clinical Biology Center, Institut Pasteur de Madagascar, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Breurec","sequence":"additional","affiliation":[{"name":"Laboratoire de Microbiologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France"},{"name":"Pathogen\u00e8se et Contr\u00f4le des Infections Chroniques et \u00c9mergentes, Inserm, Universit\u00e9 Montpellier, Universit\u00e9 des Antilles, Pointe-\u00e0-Pitre, France"},{"name":"Centre d\u2019Investigation Clinique Antilles-Guyane, Inserm Centre d'Investigation Clinique 1424 Guadeloupe, France"},{"name":"Facult\u00e9 de M\u00e9decine, Universit\u00e9 des Antilles, Guadeloupe, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Crucitti","sequence":"additional","affiliation":[{"name":"Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvain","family":"Brisse","sequence":"additional","affiliation":[{"name":"Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Universit\u00e9 Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bich-Tram","family":"Huynh","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Interactions and Antimicrobial Resistance Team, Centre de Recherche en \u00c9pid\u00e9miologie et Sant\u00e9 des Populations, Universit\u00e9 Paris-Saclay, Universit\u00e9 de Versailles Saint-Quentin-en-Yvelines, Inserm, Montigny-Le-Bretonneux, France"},{"name":"Epidemiology and Modelling of Antibacterial Evasion, Institut Pasteur, Universit\u00e9 Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"issue":"10325","key":"zoi260610r1","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis.","volume":"399","author":"Antimicrobial Resistance Collaborators","year":"2022","journal-title":"Lancet"},{"issue":"2","key":"zoi260610r3","doi-asserted-by":"publisher","first-page":"e201","DOI":"10.1016\/S2214-109X(23)00539-9","article-title":"The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis.","volume":"12","author":"Antimicrobial Resistance Collaborators","year":"2024","journal-title":"Lancet Glob Health"},{"issue":"1","key":"zoi260610r4","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanmic.2024.100976","article-title":"Bacteriology testing and antimicrobial resistance detection capacity of national tiered laboratory networks in sub-Saharan Africa: an analysis from 14 countries.","volume":"6","author":"Ondoa","year":"2025","journal-title":"Lancet Microbe"},{"issue":"7","key":"zoi260610r6","doi-asserted-by":"publisher","first-page":"e547","DOI":"10.1016\/S2542-5196(23)00127-4","article-title":"Determinants of worldwide antibiotic resistance dynamics across drug-bacterium pairs: a multivariable spatial-temporal analysis using ATLAS.","volume":"7","author":"Rahbe","year":"2023","journal-title":"Lancet Planet Health"},{"issue":"6","key":"zoi260610r7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004638","article-title":"Antimicrobial resistance in Africa: a retrospective analysis of data from 14 countries, 2016-2019.","volume":"22","author":"Osena","year":"2025","journal-title":"PLoS Med"},{"key":"zoi260610r9","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s12941-014-0061-1","article-title":"Antibiotic resistance and genotype of beta-lactamase producing Escherichia coli in nosocomial infections in Cotonou, Benin.","volume":"14","author":"Anago","year":"2015","journal-title":"Ann Clin Microbiol Antimicrob"},{"issue":"3","key":"zoi260610r10","doi-asserted-by":"publisher","first-page":"187","DOI":"10.3855\/jidc.34","article-title":"Increasing prevalence of antimicrobial resistance among Enterobacteriaceae uropathogens in Bangui, Central African Republic.","volume":"3","author":"Bercion","year":"2009","journal-title":"J Infect Dev Ctries"},{"issue":"1","key":"zoi260610r11","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1093\/jac\/dki158","article-title":"Risk factors for antibiotic-resistant Escherichia coli isolated from community-acquired urinary tract infections in Dakar, Senegal.","volume":"56","author":"Dromigny","year":"2005","journal-title":"J Antimicrob Chemother"},{"issue":"5","key":"zoi260610r12","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/S0924-8579(02)00196-6","article-title":"Distribution and susceptibility of bacterial urinary tract infections in Dakar, Senegal.","volume":"20","author":"Dromigny","year":"2002","journal-title":"Int J Antimicrob Agents"},{"issue":"3","key":"zoi260610r13","doi-asserted-by":"publisher","first-page":"263","DOI":"10.3855\/jidc.362","article-title":"Antimicrobial resistance in outpatient Escherichia coli urinary isolates in Dakar, Senegal.","volume":"1","author":"Sire","year":"2007","journal-title":"J Infect Dev Ctries"},{"key":"zoi260610r14","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1186\/s13104-015-1380-9","article-title":"Evaluation of antimicrobial susceptibility of Escherichia coli strains isolated in Rabat University Hospital (Morocco).","volume":"8","author":"Alem","year":"2015","journal-title":"BMC Res Notes"},{"key":"zoi260610r15","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.720701","article-title":"Antibiotic resistance pattern of extended spectrum beta lactamase producing Escherichia coli isolated from patients with urinary tract infection in Morocco.","volume":"11","author":"Kettani Halabi","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"issue":"2","key":"zoi260610r16","doi-asserted-by":"publisher","first-page":"189","DOI":"10.18683\/germs.2021.1256","article-title":"Update on the resistance of Escherichia coli isolated from urine specimens in a Moroccan hospital: a review of a 7-year period.","volume":"11","author":"Benaissa","year":"2021","journal-title":"Germs"},{"key":"zoi260610r17","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/3240268","article-title":"Bacterial etiology and antibiotic resistance profile of community-acquired urinary tract infections in a Cameroonian city.","volume":"2016","author":"Nzalie","year":"2016","journal-title":"Int J Microbiol"},{"issue":"1","key":"zoi260610r18","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/s12879-025-10483-8","article-title":"High prevalence of multidrug resistant and extended-spectrum \u00df-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolated from urinary tract infections in the West Region, Cameroon.","volume":"25","author":"Bayaba","year":"2025","journal-title":"BMC Infect Dis"},{"issue":"1","key":"zoi260610r19","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1186\/s12879-023-08742-7","article-title":"Phenotypic and genotypic characterization of multidrug resistant and extended-spectrum \u00df-lactamase-producing Enterobacterales isolated from clinical samples in the western region in Cameroon.","volume":"23","author":"Nkengkana","year":"2023","journal-title":"BMC Infect Dis"},{"issue":"2","key":"zoi260610r20","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s40801-018-0132-2","article-title":"Pattern of antimicrobial resistance among bacterial isolates from urogenital clinical specimens: a descriptive study from the Buea Health District, Cameroon.","volume":"5","author":"Amin","year":"2018","journal-title":"Drugs Real World Outcomes"},{"issue":"2","key":"zoi260610r21","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1093\/jac\/dkl466","article-title":"Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in Antananarivo, Madagascar.","volume":"59","author":"Randrianirina","year":"2007","journal-title":"J Antimicrob Chemother"},{"issue":"5","key":"zoi260610r22","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.medmal.2015.03.006","article-title":"Changing profile and increasing antimicrobial resistance of uropathogenic bacteria in Madagascar.","volume":"45","author":"Rasamiravaka","year":"2015","journal-title":"Med Mal Infect"},{"key":"zoi260610r23","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/1756-0500-5-219","article-title":"Etiologic profile and antimicrobial susceptibility of community-acquired urinary tract infection in two Cameroonian towns.","volume":"5","author":"Akoachere","year":"2012","journal-title":"BMC Res Notes"},{"issue":"1","key":"zoi260610r24","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1186\/s12894-024-01654-x","article-title":"Multidrug resistance in urinary E. coli higher in males compared to females.","volume":"24","author":"Khanal","year":"2024","journal-title":"BMC Urol"},{"issue":"1","key":"zoi260610r25","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/1471-2334-13-19","article-title":"Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study (2000-2009).","volume":"13","author":"Linhares","year":"2013","journal-title":"BMC Infect Dis"},{"issue":"6","key":"zoi260610r26","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1093\/cid\/ciab250","article-title":"Antimicrobial resistance patterns of urinary Escherichia coli among outpatients in Washington State, 2013-2017: associations with age and sex.","volume":"73","author":"Frisbie","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"133","key":"zoi260610r28","doi-asserted-by":"publisher","DOI":"10.1098\/rsif.2017.0295","article-title":"Host population structure and treatment frequency maintain balancing selection on drug resistance.","volume":"14","author":"Cobey","year":"2017","journal-title":"J R Soc Interface"},{"issue":"12","key":"zoi260610r29","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2024-018265","article-title":"Infection prevention and healthcare epidemiology professionals in low- and middle-income countries: a needs assessment survey and call for action.","volume":"10","author":"Sreeramoju","year":"2025","journal-title":"BMJ Glob Health"},{"key":"zoi260610r5","volume-title":"WHO Bacterial Priority Pathogens List 2024: Bacterial Pathogens of Public Health Importance, to Guide Research, Development, and Strategies to Prevent and Control Antimicrobial Resistance","author":"World Health Organization","year":"2024"},{"key":"zoi260610r2","unstructured":"WHO Global Antimicrobial Resistance and Use Surveillance System. Global antibiotic resistance surveillance report 2025. World Health Organization. Accessed October 15, 2025. https:\/\/www.who.int\/publications\/i\/item\/9789240116337"},{"key":"zoi260610r8","doi-asserted-by":"crossref","unstructured":"Vanegas? LH, Rond\u00f3n? LM, Paula? GA. Glmtoolbox: set of tools to data analysis using generalized linear models. Published online April 13, 2021. Accessed June 2, 2026. https:\/\/cran.r-project.org\/web\/packages\/glmtoolbox\/index.html","DOI":"10.32614\/CRAN.package.glmtoolbox"},{"key":"zoi260610r27","unstructured":"World Health Organization. AWARE classification of antibiotics for evaluation and monitoring of use, 2023. Accessed July 30, 2025. https:\/\/www.who.int\/publications\/i\/item\/WHO-MHP-HPS-EML-2023.04"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2851454\/rafetrarivony_2026_oi_260610_1782932623.60104.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:00:21Z","timestamp":1783609221000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2851454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.21865","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]}}}