{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:05:23Z","timestamp":1791439523366,"version":"4.3.3"},"reference-count":29,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008593","name":"European Respiratory Society","doi-asserted-by":"publisher","award":["CRC-2021-08"],"award-info":[{"award-number":["CRC-2021-08"]}],"id":[{"id":"10.13039\/100008593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2026,8,19]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antimicrobial resistance (AMR) is a global threat for people with chronic lung infection; however, international AMR epidemiology in bronchiectasis and cystic fibrosis (CF) is poorly characterised. In this study, we retrospectively analyse international longitudinal AMR epidemiology in bronchiectasis and CF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Microbiology data were analysed from 110\u2009323 respiratory samples in 19\u2009143 individuals with bronchiectasis or CF across 11 cities, eight countries, three continents between 2011 and 2024. Longitudinal AMR prevalence, multidrug-resistant (MDR) and extensively drug-resistant (XDR) prevalence and multiple antibiotic resistance (MAR) index were analysed by disease and country. Pilot analysis of concurrent\/disjoint resistance in antimicrobial pairs and triplets in regional datasets was performed to inform combination or cyclical antimicrobial choice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Geographic AMR differences were noted across pathogens in bronchiectasis and CF with increased\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      resistance in central\/southern Europe and increased\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      resistance in Hong Kong. MDR burden was high in emergent pathogens\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      (CF: MDR 32.6%; XDR 12.4%; bronchiectasis: MDR 39.2%; XDR 4.9%) and\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      (CF: MDR 22.7%; XDR 15.6%; bronchiectasis: MDR 13.4%; XDR 1.5%). A longitudinal rise in\n                      <jats:italic>P. aeruginosa<\/jats:italic>\n                      AMR was seen in bronchiectasis across four centres for antipseudomonal aminoglycosides (p&lt;0.001; OR\/year 1.44; 95%\u2009CI 1.24 to 1.67), fluoroquinolones (p=0.002; OR\/year 1.13; 95%\u2009CI 1.05 to 1.23), cephalosporins (p=0.005; OR\/year 1.17; 95%\u2009CI 1.05 to 1.30), penicillins with beta-lactamase inhibitor (p=0.02; OR\/year 1.18; 95%\u2009CI 1.03 to 1.35) and carbapenems (p=0.048; OR\/year 1.11; 95%\u2009CI 1.00 to 1.23). Rising longitudinal\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      AMR was seen for cephalosporins (p=0.01; OR\/year 1.32; 95%\u2009CI 1.06 to 1.65) and carbapenems (p=0.04; OR\/year 1.64; 95%\u2009CI 1.03 to 2.62). A significant increase in AMR, as measured by the MAR index, was observed in individuals with residual culture-positive CF receiving triple cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy (p&lt;0.001). Strong concurrent resistance was noted in bronchiectasis across regions with geographic variation in disjoint antimicrobial pair resistance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We show a significant increasing international AMR burden in bronchiectasis and CF, with geographic variation and persistence post-CFTR modulator therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/thorax-2026-225527","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:20:38Z","timestamp":1790011238000},"page":"thorax-2026-225527","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["International epidemiology of antimicrobial resistance in people living with chronic lung infection"],"prefix":"10.1136","author":[{"given":"Ollie","family":"Pitts","sequence":"first","affiliation":[{"name":"Centre of Bacterial Resistance Biology, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Premuda","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy"},{"name":"Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4635-4525","authenticated-orcid":false,"given":"ZhiLing","family":"Yuan","sequence":"additional","affiliation":[{"name":"Division of Respiratory Medicine, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4735-823X","authenticated-orcid":false,"given":"Mattia","family":"Nigro","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Milan, Italy"},{"name":"Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"Othmer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charite - Universitatsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolas","family":"Johl","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Cardiff and Vale University Health Board, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8701-2693","authenticated-orcid":false,"given":"Arafa","family":"Aboelhassan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Assiut University, Asyut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safaa","family":"Eid","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Assiut University, Asyut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Hashem","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Assiut University, Asyut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noha","family":"Khalil","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Assiut University, Asyut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Behnke","sequence":"additional","affiliation":[{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Hygiene and Environmental Medicine, Charite - 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