{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:03:20Z","timestamp":1789103000905,"version":"build-2803163510"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Infection"],"published-print":{"date-parts":[[2026,6]]},"abstract":"\n Background:<\/jats:title>\n \n Antimicrobial resistance (AMR) in\n Escherichia coli<\/jats:italic>\n ,\n Klebsiella pneumoniae<\/jats:italic>\n , and\n Enterobacter cloacae<\/jats:italic>\n is a global threat, yet data from Belize and the wider Caribbean are scarce. Understanding local resistance patterns is critical for effective treatment and stewardship.\n <\/jats:p>\n <\/jats:sec>\n \n Objectives:<\/jats:title>\n To determine antibiotic susceptibility patterns, quantify multidrug resistance (MDR) in outpatient and inpatient settings, identify predictors of empirical treatment failure for urinary tract infections (UTIs), and analyze temporal and geographic trends.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Nationwide retrospective analysis of clinical isolates from Belize\u2019s public health system (2018\u20132023).<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We analyzed 4591 clinical isolates. MDR was defined as non-susceptibility to \u2a7e3 drug categories. Multivariable logistic regression identified predictors of the risk of empirical treatment failure for UTIs. Joinpoint regression analyzed temporal trends. Geospatial analysis mapped hotspots of incidence and resistance.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n E. coli<\/jats:italic>\n was predominant (68%). Among 3005 urinary isolates, 1247 (41.5%) were resistant to both first-line oral antibiotics (ciprofloxacin and trimethoprim-sulfamethoxazole). Extended-spectrum \u03b2-lactamase (ESBL) production (adjusted odds ratio (aOR) 8.91, 95% CI 7.40\u201310.73), infection with\n K. pneumoniae<\/jats:italic>\n (aOR 2.85, 95% CI 2.32\u20133.51) or\n E. cloacae<\/jats:italic>\n (aOR 4.12, 95% CI 2.78\u20136.11), and older age were key predictors. Ciprofloxacin resistance in\n E. coli<\/jats:italic>\n increased significantly post-2020 (Annual Percent Change 9.8%,\n p<\/jats:italic>\n = 0.02). MDR was prevalent in outpatient settings (42.1% for\n E. coli<\/jats:italic>\n , 61.2% for\n K. pneumoniae<\/jats:italic>\n ). Geospatial analysis revealed the Belize District as the incidence hotspot, while the Toledo District was the ESBL prevalence hotspot (29.5%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Belize faces a notable AMR crisis characterized by a high community burden of MDR Enterobacterales, a critical empirical treatment gap for UTIs, and accelerating resistance trends.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/20499361261458469","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T09:33:55Z","timestamp":1781602435000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Treatment gaps and risk factors for multidrug-resistant Enterobacterales in Belize: a 6-year (2018\u20132023) nationwide retrospective analysis"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5426-7315","authenticated-orcid":false,"given":"Innocent","family":"Nwachukwu","sequence":"first","affiliation":[{"name":"Department of Allied Health (Medical Laboratory Science), Faculty of Health, University of Belize, Belmopan Central Campus, Belmopan, Belize, Central America"},{"name":"Antimicrobial Resistance (AMR) Study Group, Faculty of Health Sciences, Allied Health Department, University of Belize, Belmopan Central Campus, Belmopan, Belize, Central America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camryn","family":"Linares","sequence":"additional","affiliation":[{"name":"Department of Allied Health (Medical Laboratory Science), Faculty of Health, University of Belize, Belize, Central America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Griseidy","family":"Alcoser","sequence":"additional","affiliation":[{"name":"Department of Allied Health (Medical Laboratory Science), Faculty of Health, University of Belize, Belize, Central America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nivi","family":"Novelo","sequence":"additional","affiliation":[{"name":"Department of Allied Health (Medical Laboratory Science), Faculty of Health, University of Belize, Belize, Central America"}],"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":"Department of Allied Health (Pharmacy and Public Health), Faculty of Health, University of Belize, Belmopan Central Campus, 340, Belize, Central America"},{"name":"Antimicrobial Resistance (AMR) Study Group, Faculty of Health Sciences, Allied Health Department, University of Belize, Belmopan Central Campus, Belmopan, Belize, Central America"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"World Health Organization. Antimicrobial resistance [Internet] https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/antimicrobial-resistance (2023 accessed 18 November 2025)."},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/epidemiologia6020021"},{"key":"e_1_3_4_4_2","volume-title":"Textbook of diagnostic microbiology\u2013E-Book","author":"Mahon CR","year":"2018","unstructured":"Mahon CR, Lehman DC. Textbook of diagnostic microbiology\u2013E-Book. 6th ed. Elsevier Health Sciences, St. Louis, MO, 2018.","edition":"6"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-89123-9"},{"issue":"9","key":"e_1_3_4_6_2","article-title":"Antibiotic resistance: The challenges and some emerging strategies for tackling a global menace","volume":"36","author":"Nwobodo DC","year":"2022","unstructured":"Nwobodo DC, Ugwu MC, Oliseloke Anie C, et al. Antibiotic resistance: The challenges and some emerging strategies for tackling a global menace. J Clin Lab Anal 2022; 36(9): e24655.","journal-title":"J Clin Lab Anal"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.24655"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0234814"},{"issue":"2","key":"e_1_3_4_9_2","article-title":"Antimicrobial resistance in the Caribbean","volume":"87","author":"Nagassar RP","year":"2022","unstructured":"Nagassar RP, Daniel K, Peters K, et al. Antimicrobial resistance in the Caribbean. Caribb Med J 2022; 87(2).","journal-title":"Caribb Med J"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/7656752"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/02664763.2023.2272223"},{"key":"e_1_3_4_12_2","unstructured":"National Cancer Institute at the NIH. (n.d.). Joinpoint Trend Analysis Software. Joinpoint Regression Program. https:\/\/surveillance.cancer.gov\/joinpoint\/"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.811"},{"key":"e_1_3_4_14_2","unstructured":"R Project . (n.d.). The R project for statistical computing. R. https:\/\/www.r-project.org\/"},{"key":"e_1_3_4_15_2","unstructured":"R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing Vienna Austria. https:\/\/www.R-project.org\/."},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlab092"},{"key":"e_1_3_4_17_2","first-page":"1","article-title":"Antibiotic resistance patterns in uropathogens: insights from a Nepalese tertiary care setting","volume":"12","author":"Thapa RB","year":"2025","unstructured":"Thapa RB, Shrestha S, Adhikari P, et al. Antibiotic resistance patterns in uropathogens: insights from a Nepalese tertiary care setting. Therap Adv Infect Dis 2025; 12: 1\u20137.","journal-title":"Therap Adv Infect Dis"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191911931"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.101848"},{"issue":"1","key":"e_1_3_4_20_2","article-title":"Post-COVID-19 medication adherence among HIV\/AIDS patients in Belize: a case for consolidating education and monitoring","volume":"2025","author":"Husaini DC","year":"2025","unstructured":"Husaini DC, Parchue J, Orellana-Erazo A, et al. Post-COVID-19 medication adherence among HIV\/AIDS patients in Belize: a case for consolidating education and monitoring. AIDS Res Treat 2025; 2025(1): 5552340.","journal-title":"AIDS Res Treat"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.microb.2026.100696"},{"issue":"3","key":"e_1_3_4_22_2","article-title":"Antimicrobial resistance in surgical site and wound infections in Belize: a seven-year national surveillance analysis, 2018-2024","volume":"15","author":"Nwachukwu I","year":"2026","unstructured":"Nwachukwu I, Rivera CW, Reyes VM, et al. Antimicrobial resistance in surgical site and wound infections in Belize: a seven-year national surveillance analysis, 2018-2024. MicrobiologyOpen 2026; 15(3): e70312.","journal-title":"MicrobiologyOpen"},{"key":"e_1_3_4_23_2","first-page":"1","article-title":"Over-the-counter sales of antibiotics at community pharmacies in Belize: a cross-sectional simulated client visit study","volume":"8","author":"Husaini DC","year":"2021","unstructured":"Husaini DC, Abubakar Y, Harris-Thurton L, et al. Over-the-counter sales of antibiotics at community pharmacies in Belize: a cross-sectional simulated client visit study. Integrative J Med Sci 2021; 8: 1-5.","journal-title":"Integrative J Med Sci"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1108\/IJPHM-07-2022-0061"}],"container-title":["Therapeutic Advances in Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20499361261458469","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20499361261458469","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20499361261458469","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T10:20:02Z","timestamp":1781778002000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20499361261458469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":23,"alternative-id":["10.1177\/20499361261458469"],"URL":"https:\/\/doi.org\/10.1177\/20499361261458469","relation":{},"ISSN":["2049-9361","2049-937X"],"issn-type":[{"value":"2049-9361","type":"print"},{"value":"2049-937X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"article-number":"20499361261458469"}}