{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:12:44Z","timestamp":1787764364833,"version":"build-2784847793"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["MicrobiologyOpen"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      Antimicrobial resistance (AMR) poses a critical threat to surgical care in resource\u2010limited settings. This study describes the epidemiology of AMR in surgical site and wound infections in Belize from 2018 to 2024. Methods: A retrospective analysis of national laboratory data focused on\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      ,\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      , and\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      from surgical and wound specimens. Resistance phenotypes (ESBL, MRSA), susceptibility profiles, and temporal\u2010spatial trends were analyzed. Results: Among 850 isolates, ESBL production among Enterobacteriaceae more than doubled from 25% to &gt;\u200945% over 7 years, while MRSA remained persistently elevated (55%\u201365%). Critical treatment gaps emerged: over one\u2010third of ESBL isolates showed resistance to both oral (ciprofloxacin) and intravenous (gentamicin) options. ESBL infections clustered in central Belize and following cesarean sections; MRSA predominated in diabetic amputations. Antibiotic consumption preceded resistance by approximately 6 months. Sentinel carbapenem\u2010resistant Enterobacteriaceae and vancomycin\u2010resistant Enterococcus were detected. Conclusion: AMR is prevalent in Belize, with rapidly expanding ESBL rates and significant therapeutic limitations. Urgent interventions are needed, including updated treatment guidelines, targeted antimicrobial stewardship, and enhanced infection control in high\u2010burden areas.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mbo3.70312","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T12:12:59Z","timestamp":1778501579000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["When First\u2010Line Therapies Fail: Surgical Site Infections and the Declining Antimicrobial Utility in a Resource\u2010Limited Nation"],"prefix":"10.1002","volume":"15","author":[{"given":"Innocent E.","family":"Nwachukwu","sequence":"first","affiliation":[{"name":"Department of Allied Health (Medical Laboratory Science), Faculty of Health Sciences University of Belize Belmopan Central Campus, Central America Belize"},{"name":"Antimicrobial Resistance (AMR) Study Group, Allied Health Department, Faculty of Health Sciences University of Belize Belmopan C.A Belize"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary W.","family":"Rivera","sequence":"additional","affiliation":[{"name":"Department of Allied Health (Medical Laboratory Science), Faculty of Health Sciences University of Belize Belmopan Central Campus, Central America Belize"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian M.","family":"Reyes","sequence":"additional","affiliation":[{"name":"Department of Allied Health (Medical Laboratory Science), Faculty of Health Sciences University of Belize Belmopan Central Campus, Central America Belize"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diomar","family":"Salazar","sequence":"additional","affiliation":[{"name":"Department of Allied Health (Medical Laboratory Science), Faculty of Health Sciences University of Belize Belmopan Central Campus, Central America Belize"},{"name":"Antimicrobial Resistance (AMR) Study Group, Allied Health Department, Faculty of Health Sciences University of Belize Belmopan C.A Belize"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Harris\u2010Thurton","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance (AMR) Study Group, Allied Health Department, Faculty of Health Sciences University of Belize Belmopan C.A Belize"},{"name":"Department of Allied Health (Pharmacy &amp; Public Health), Faculty of Health Sciences University of Belize Belmopan Central Campus, Central America Belize"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1655-2873","authenticated-orcid":false,"given":"Danladi C.","family":"Husaini","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance (AMR) Study Group, Allied Health Department, Faculty of Health Sciences University of Belize Belmopan C.A Belize"},{"name":"Department of Allied Health (Pharmacy &amp; Public Health), Faculty of Health Sciences University of Belize Belmopan Central Campus, Central America Belize"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/idr.s371845"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12049"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1590\/s1020-49892004000800007"},{"key":"e_1_2_14_5_1","unstructured":"CDC. 2023. 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Health statistics. Statistical Institute of Belize.https:\/\/sib.org.bz\/statistics\/other-statistics\/health-statistics\/."},{"key":"e_1_2_14_26_1","unstructured":"Tuyud V. et al.2018. \u201cAntibiotic Resistance Patterns of Pathogens Isolated from Surgical Site Infections at Public Health Facilities in Belize\u2019 \u201dJournal of Antibiotics Research2 no. 2: 203.https:\/\/www.annexpublishers.com\/articles\/JAR\/2203-Antibiotic-Resistance-Patterns-of-Pathogens-Isolated-from-Surgical-Site-Infections-at-Public-Health-Facilities-in-Belize.pdf."},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2711.210097"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2021.362"},{"key":"e_1_2_14_29_1","unstructured":"WHO.2023. Antimicrobial Resistance 21 November. 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