{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:55:08Z","timestamp":1792788908195,"version":"4.5.0"},"reference-count":95,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fleming Fund Zambia Country Grant"},{"name":"Zambia Multisectoral Pandemic Preparedness and Response (ZaMPPR) Project"},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"crossref","award":["JP20wm0125008"],"award-info":[{"award-number":["JP20wm0125008"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"crossref","award":["JP223fa627005"],"award-info":[{"award-number":["JP223fa627005"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: The right diagnostic tests, for the right patient, at the right time, are key to optimising antimicrobial use (AMU) and preventing antimicrobial resistance (AMR). This study evaluated diagnostic stewardship trends and AMR patterns in Zambian surveillance sentinel sites from 2020 to 2024. Methods: This descriptive, retrospective study analysed routine laboratory data from January 2020 to December 2024 at seven designated AMR surveillance sentinel sites across Zambia. Data on clinical specimens submitted for antimicrobial susceptibility testing were extracted from WHONET and analysed by year, specimen type, and antimicrobial susceptibility profile. Results: A total of 184,788 bacteriology specimens were processed over five years. Urine was the most frequently collected specimen, peaking above 20,000 in 2024. Escherichia coli was the most commonly isolated organism among 15 priority pathogens, comprising 25.9% of the 30,013 isolates. Though a statistically significant increasing trend in total organism isolations was observed annually, only Shigella sp. demonstrated a substantial increase in non-susceptibility to azithromycin (p = 0.027). High resistance was observed with doxycycline, azithromycin, clindamycin, trimethoprim\/sulfamethoxazole, ciprofloxacin, and rifampicin, exhibiting resistance ranging from 50% to 80%. Critical AMR alerts included 65% for Vancomycin-Resistant Enterococcus (VRE), 72% for linezolid, and 44% for carbapenems, and possible ESBL-producing Enterobacterales showing the highest overall resistance at 35%, across sentinel sites. Conclusions: Zambia faces a concerning and significant increase in AMR, with high resistance prevalence across commonly used antibiotics. Critical resistance alerts for VRE, linezolid, carbapenems, and possible ESBL-producing Enterobacterales underscore an urgent need for robust antimicrobial stewardship and continuous diagnostic surveillance.<\/jats:p>","DOI":"10.3390\/antibiotics14111136","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T08:57:55Z","timestamp":1762765075000},"page":"1136","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Diagnostic Stewardship Trends and Antimicrobial Resistance Profiles of Bacteria Isolated in Zambia: A Five-Year Retrospective Study (2020\u20132024)"],"prefix":"10.3390","volume":"14","author":[{"given":"Joseph Yamweka","family":"Chizimu","sequence":"first","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2554-1236","authenticated-orcid":false,"given":"Aubrey Chichonyi","family":"Kalungia","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1692-8981","authenticated-orcid":false,"given":"Steward","family":"Mudenda","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"},{"name":"Department of Pharmacy, University of Zambia, Lusaka 10101, Zambia"},{"name":"Education and Continuous Professional Development Committee, Pharmaceutical Society of Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoran","family":"Muhimba","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"},{"name":"Department of Pathology, University Teaching Hospitals, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chileshe","family":"Lukwesa","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Webrod","family":"Mufwambi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of Zambia, Lusaka 10101, Zambia"},{"name":"Education and Continuous Professional Development Committee, Pharmaceutical Society of Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amon","family":"Siame","sequence":"additional","affiliation":[{"name":"Centres for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Mwangilwa","sequence":"additional","affiliation":[{"name":"Surveillance and Disease Intelligence Cluster, Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8937-3142","authenticated-orcid":false,"given":"Priscilla","family":"Gardner","sequence":"additional","affiliation":[{"name":"Surveillance and Disease Intelligence Cluster, Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8973-9474","authenticated-orcid":false,"given":"Jimmy","family":"Hangoma","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Levy Mwanawasa Medical University, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9490-5609","authenticated-orcid":false,"given":"Victor","family":"Daka","sequence":"additional","affiliation":[{"name":"Department of Public Health, Copperbelt University, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chikwanda","family":"Chileshe","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"},{"name":"Department of Biomedical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4013-7843","authenticated-orcid":false,"given":"Ntombi B.","family":"Mudenda","sequence":"additional","affiliation":[{"name":"Department of Clinical Studies, University of Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1724-7934","authenticated-orcid":false,"given":"Maisa","family":"Kasanga","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"},{"name":"Department of Pathology and Microbiology, University Teaching Hospitals, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misheck","family":"Shawa","sequence":"additional","affiliation":[{"name":"Hokudai Center for Zoonosis Control in Zambia, Hokkaido University, Lusaka 10101, Zambia"},{"name":"Division of International Research Promotion, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herman","family":"Chambaro","sequence":"additional","affiliation":[{"name":"Department of Veterinary Services, Ministry of Fisheries and Livestock, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5477-9054","authenticated-orcid":false,"given":"Duncan","family":"Chanda","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Teaching Hospitals, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taona","family":"Sinyawa","sequence":"additional","affiliation":[{"name":"Central Veterinary Research Institute, Ministry of Fisheries and Livestock, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertha","family":"Chibwe","sequence":"additional","affiliation":[{"name":"Centres for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaunda","family":"Kaunda","sequence":"additional","affiliation":[{"name":"Centres for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaunda","family":"Yamba","sequence":"additional","affiliation":[{"name":"Action on Antibiotic Resistance (ReAct) Africa, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O-Tipo","family":"Shikanga","sequence":"additional","affiliation":[{"name":"Department of Health, World Health Organization, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freddie","family":"Masaninga","sequence":"additional","affiliation":[{"name":"Department of Health, World Health Organization, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mpela","family":"Chibi","sequence":"additional","affiliation":[{"name":"Department of Health, World Health Organization, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra Diana","family":"Mwadetsa","sequence":"additional","affiliation":[{"name":"Department of Health, World Health Organization, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4945-6746","authenticated-orcid":false,"given":"Doreen Mainza","family":"Shempela","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6480-6885","authenticated-orcid":false,"given":"Mwendalubi Albert","family":"Hadunka","sequence":"additional","affiliation":[{"name":"Centres for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samson","family":"Mukale","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Bambala","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University Teaching Hospitals, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4148-1993","authenticated-orcid":false,"given":"Malambo","family":"Mutila","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loveness","family":"Sakalimbwe","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred Mulako","family":"Simwinji","sequence":"additional","affiliation":[{"name":"Centres for Infectious Disease Research in Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Mainda","sequence":"additional","affiliation":[{"name":"Food and Agriculture Organization of the United Nations, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chie","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Japan"},{"name":"Division of Research Support, Hokkaido University Institute for Vaccine Research and Development, Sapporo 001-0020, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Nakazwe","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"},{"name":"Department of Pathology and Microbiology, University Teaching Hospitals, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fusya","family":"Goma","sequence":"additional","affiliation":[{"name":"Central Veterinary Research Institute, Ministry of Fisheries and Livestock, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyambe","family":"Sinyange","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1313-1494","authenticated-orcid":false,"given":"Yasuhiko","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Japan"},{"name":"Division of Research Support, Hokkaido University Institute for Vaccine Research and Development, Sapporo 001-0020, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6180-4051","authenticated-orcid":false,"given":"John Bwalya","family":"Muma","sequence":"additional","affiliation":[{"name":"Department of Disease Control, University of Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0221-9527","authenticated-orcid":false,"given":"Roma","family":"Chilengi","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1179\/2047773215Y.0000000030","article-title":"Antimicrobial resistance: A global multifaceted phenomenon","volume":"109","author":"Prestinaci","year":"2015","journal-title":"Pathog. Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Salam, M.A., Al-Amin, M.Y., Salam, M.T., Pawar, J.S., Akhter, N., Rabaan, A.A., and Alqumber, M.A.A. (2023). Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare, 11.","DOI":"10.20944\/preprints202305.0555.v1"},{"key":"ref_3","doi-asserted-by":"crossref","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":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1080\/14740338.2022.2106368","article-title":"Tackling antimicrobial resistance across sub-Saharan Africa: Current challenges and implications for the future","volume":"21","author":"Godman","year":"2022","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Saleem, Z., Godman, B., Cook, A., Khan, M.A., Campbell, S.M., Seaton, R.A., Siachalinga, L., Haseeb, A., Amir, A., and Kurdi, A. (2022). Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future. Antibiotics, 11.","DOI":"10.3390\/antibiotics11121824"},{"key":"ref_6","doi-asserted-by":"crossref","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":"Sartorius","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"106816","DOI":"10.1016\/j.ijantimicag.2023.106816","article-title":"Diagnostic stewardship in infectious diseases: A continuum of antimicrobial stewardship in the fight against antimicrobial resistance","volume":"62","author":"Zakhour","year":"2023","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2022-9-5","DOI":"10.7573\/dic.2022-9-5","article-title":"Leveraging diagnostic stewardship within antimicrobial stewardship programmes","volume":"12","author":"Claeys","year":"2023","journal-title":"Drugs Context"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1017\/ice.2023.284","article-title":"Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics","volume":"45","author":"Singh","year":"2024","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_10","unstructured":"World Health Organization (2025, June 20). Diagnostic Stewardship: A Guide to Implementation in Antimicrobial Resistance Surveillance Sites. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-DGO-AMR-2016.3."},{"key":"ref_11","first-page":"5","article-title":"Zambia Successfully Launches the First Multi-Sectoral National Action Plan on Antimicrobial Resistance (AMR)","volume":"1","author":"Kapona","year":"2017","journal-title":"Health Press Zamb. Bull."},{"key":"ref_12","unstructured":"World Health Organization (2020, October 20). Global Action Plan on Antimicrobial Resistance. Available online: https:\/\/www.who.int\/antimicrobial-resistance\/publications\/global-action-plan\/en\/."},{"key":"ref_13","unstructured":"World_Health_Organization (2025, June 17). Monitoring and Evaluation of the Global Action Plan on Antimicrobial Resistance. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/325006\/9789241515665-eng.pdf?sequence=1&isAllowed=y."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"403","DOI":"10.4236\/pp.2024.1512024","article-title":"The Burden of Antimicrobial Resistance in Zambia, a Sub-Saharan African Country: A One Health Review of the Current Situation, Risk Factors, and Solutions","volume":"15","author":"Mudenda","year":"2024","journal-title":"Pharmacol. Pharm."},{"key":"ref_15","unstructured":"World Health Organization (2025, June 17). Global Antimicrobial Resistance Surveillance System: Manual for Early Implementation. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241549400."},{"key":"ref_16","unstructured":"World Health Organization (2021). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2021, World Health Organization."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s42269-023-00986-2","article-title":"Mapping and gap analysis on antimicrobial resistance surveillance systems in Kenya, Tanzania, Uganda and Zambia","volume":"47","author":"Matee","year":"2023","journal-title":"Bull. Natl. Res. Cent."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.jhin.2024.03.014","article-title":"Assessment of Antimicrobial Resistance Laboratory-based Surveillance Capacity of Hospitals in Zambia: Findings and Implications for System Strengthening","volume":"148","author":"Yamba","year":"2024","journal-title":"J. Hosp. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/jac\/dkac342","article-title":"Systematic review of surveillance systems for AMR in Africa","volume":"78","author":"Okolie","year":"2022","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1016\/j.cmi.2021.05.027","article-title":"Setting up laboratory-based antimicrobial resistance surveillance in low- and middle-income countries: Lessons learned from Georgia","volume":"27","author":"Malania","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"107828","DOI":"10.1016\/j.ijid.2025.107828","article-title":"AMR Surveillance in Africa: Are We There Yet?","volume":"152","author":"Essack","year":"2025","journal-title":"Int. J. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s13756-024-01472-8","article-title":"Enhancing clinical microbiology for genomic surveillance of antimicrobial resistance implementation in Africa","volume":"13","author":"Kajumbula","year":"2024","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Musa, K., Okoliegbe, I., Abdalaziz, T., Aboushady, A.T., Stelling, J., and Gould, I.M. (2023). Laboratory Surveillance, Quality Management, and Its Role in Addressing Antimicrobial Resistance in Africa: A Narrative Review. Antibiotics, 12.","DOI":"10.3390\/antibiotics12081313"},{"key":"ref_24","first-page":"1","article-title":"The SLMTA programme: Transforming the laboratory landscape in developing countries","volume":"5","author":"Yao","year":"2016","journal-title":"Afr. J. Lab. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"109046","DOI":"10.1016\/j.envint.2024.109046","article-title":"Towards integrated cross-sectoral surveillance of pathogens and antimicrobial resistance: Needs, approaches, and considerations for linking surveillance to action","volume":"192","author":"Lappan","year":"2024","journal-title":"Environ. Int."},{"key":"ref_26","unstructured":"Dacombe, R., Bates, I., Bhardwaj, M., Wallis, S., and Pulford, J. (2025, June 17). Fleming Fund: Supporting Surveillance Capacity for Antimicrobial Resistance An Analysis of Approaches to Laboratory Capacity Strengthening for Drug Resistant Infections in Low and Middle Income Countries. Available online: http:\/\/researchonline.ljmu.ac.uk\/id\/eprint\/6678\/1\/FF%20An%20analysis%20of%20approaches%20to%20lab%20cap%20strenghtening%20for%20drug%20resistant.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4102\/ajlm.v10i1.1225","article-title":"Improving laboratory quality and capacity through leadership and management training: Lessons from Zambia 2016\u20132018","volume":"10","author":"Gopolang","year":"2021","journal-title":"Afr. J. Lab. Med."},{"key":"ref_28","unstructured":"Shempela, D.M., Mudenda, S., Kasanga, M., Daka, V., Kangongwe, M.H., Kamayani, M., Sikalima, J., Yankonde, B., Kasonde, C.B., and Nakazwe, R. (2025, June 17). A Situation Analysis of the Capacity of Laboratories in Zambia to Conduct Surveillance of Antimicrobial Resistance: Strengths, Weaknesses, Opportunities, and Challenges. Available online: https:\/\/www.preprints.org\/frontend\/manuscript\/9d35f7af5f7132cc69b149b7521cf6f0\/download_pub."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.2217\/fmb-2020-0250","article-title":"Antimicrobial susceptibility Patterns of Bacteria that Commonly Cause Bacteremia at a Tertiary Hospital in Zambia","volume":"15","author":"Kasanga","year":"2020","journal-title":"Future Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"811","DOI":"10.2217\/fmb-2021-0104","article-title":"Antimicrobial Resistance Patterns of Bacterial Pathogens: Their Distribution in University Teaching Hospitals in Zambia","volume":"16","author":"Kasanga","year":"2021","journal-title":"Future Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kasanga, M., Gajd\u00e1cs, M., Muleya, W., Ikhimiukor, O.O., Mudenda, S., Kasanga, M., Chizimu, J., Shempela, D.M., Solochi, B.B., and Mwikisa, M.J. (2024). Genotypic Characterisation and Antimicrobial Resistance of Extended-Spectrum \u03b2-Lactamase-Producing Escherichia coli in Humans, Animals, and the Environment from Lusaka, Zambia: Public Health Implications and One Health Surveillance. Antibiotics, 13.","DOI":"10.3390\/antibiotics13100951"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"dlae061","DOI":"10.1093\/jacamr\/dlae061","article-title":"Antimicrobial resistance profiles of Escherichia coli isolated from clinical and environmental samples: Findings and implications","volume":"6","author":"Kasanga","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bumbangi, F.N., Llarena, A.-K., Skjerve, E., Hang\u2019ombe, B.M., Mpundu, P., Mudenda, S., Mutombo, P.B., and Muma, J.B. (2022). Evidence of Community-Wide Spread of Multi-Drug Resistant Escherichia coli in Young Children in Lusaka and Ndola Districts, Zambia. Microorganisms, 10.","DOI":"10.3390\/microorganisms10081684"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e0226676","DOI":"10.1371\/journal.pone.0226676","article-title":"Evaluation of antibiotic susceptibility patterns of pathogens isolated from routine laboratory specimens at Ndola Teaching Hospital: A retrospective study","volume":"14","author":"Chanda","year":"2019","journal-title":"PLoS ONE"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e0000623","DOI":"10.1371\/journal.pgph.0000623","article-title":"Antibiotic susceptibility patterns of pathogens isolated from laboratory specimens at Livingstone Central Hospital in Zambia","volume":"2","author":"Mwansa","year":"2022","journal-title":"PLoS Glob. Public Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s12879-017-2232-0","article-title":"Identification and antimicrobial resistance patterns of bacterial enteropathogens from children aged 0\u201359 months at the University Teaching Hospital, Lusaka, Zambia: A prospective cross sectional study","volume":"17","author":"Chiyangi","year":"2017","journal-title":"BMC Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"dlae159","DOI":"10.1093\/jacamr\/dlae159","article-title":"Carriage and antimicrobial susceptibility patterns of rectal ESBL E. coli in surgical patients at the University Teaching Hospitals in Lusaka, Zambia","volume":"6","author":"Siame","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"dlae027","DOI":"10.1093\/jacamr\/dlae027","article-title":"Antibiotic prescribing patterns and carriage of antibiotic-resistant Escherichia coli and Enterococcus species in healthy individuals from selected communities in Lusaka and Ndola districts, Zambia","volume":"6","author":"Yamba","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"887","DOI":"10.2147\/IDR.S509522","article-title":"Point Prevalence Survey of Antibiotic Use in Level 1 hospitals in Zambia: Future Prospects for Antimicrobial Stewardship Programs","volume":"18","author":"Mudenda","year":"2025","journal-title":"Infect. Drug Resist."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Kalungia, A.C., Mukosha, M., Mwila, C., Banda, D., Mwale, M., Kagulura, S., Ogunleye, O.O., Meyer, J.C., and Godman, B. (2022). Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and Implications for the Future. Antibiotics, 11.","DOI":"10.3390\/antibiotics11111626"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"dlae170","DOI":"10.1093\/jacamr\/dlae170","article-title":"Antibiotic use and adherence to the WHO AWaRe guidelines across 16 hospitals in Zambia: A point prevalence survey","volume":"6","author":"Chizimu","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"dlae023","DOI":"10.1093\/jacamr\/dlae023","article-title":"Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: Findings and implications","volume":"6","author":"Mudenda","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"42","DOI":"10.3390\/pharma2010005","article-title":"Prescribing Patterns of Antibiotics According to the WHO AWaRe Classification during the COVID-19 Pandemic at a Teaching Hospital in Lusaka, Zambia: Implications for Strengthening of Antimicrobial Stewardship Programmes","volume":"2","author":"Mudenda","year":"2023","journal-title":"Pharmacoepidemiology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"379","DOI":"10.4236\/pp.2022.1310029","article-title":"Antibiotic Prescribing Patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia","volume":"13","author":"Mudenda","year":"2022","journal-title":"Pharmacol. Pharm."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e0228555","DOI":"10.1371\/journal.pone.0228555","article-title":"Antimicrobial usage at a large teaching hospital in Lusaka, Zambia","volume":"15","author":"Masich","year":"2020","journal-title":"PLoS ONE"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"dlae034","DOI":"10.1093\/jacamr\/dlae034","article-title":"Community antibiotic consumption and associated factors in Lusaka district of Zambia: Findings and implications for antimicrobial resistance and stewardship","volume":"6","author":"Ngoma","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"dlaf085","DOI":"10.1093\/jacamr\/dlaf085","article-title":"Current status and future direction of antimicrobial stewardship programs and antibiotic prescribing in primary care hospitals in Zambia","volume":"7","author":"Makiko","year":"2025","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_48","first-page":"1","article-title":"Antibiotic Prescribing Patterns in Paediatric Patients at Levy Mwanawasa University Teaching Hospital in Lusaka, Zambia","volume":"4","author":"Kalonga","year":"2020","journal-title":"J. Pharm. Res. Sci. Technol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4236\/pp.2025.161001","article-title":"Surveillance of Antibiotic Use and Adherence to the WHO\/INRUD Core Prescribing Indicators at a Primary Healthcare Hospital in Southern Zambia: Opportunities for Antimicrobial Stewardship Programs","volume":"16","author":"Mudenda","year":"2025","journal-title":"J. Pharmacol. Pharm."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"dlae178","DOI":"10.1093\/jacamr\/dlae178","article-title":"Impact of a hub-and-spoke approach to hospital antimicrobial stewardship programmes on antibiotic use in Zambia","volume":"6","author":"Kalungia","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Mudenda, S., Kapolowe, K., Chirwa, U., Chanda, M., Chanda, R., Kalaba, R., Fwoloshi, S., Phiri, C., Mwamba, M., and Chirwa, R.K. (2025). Antimicrobial Stewardship Impact on Antibiotic Use in Three Tertiary Hospitals in Zambia: A Comparative Point Prevalence Survey. Antibiotics, 14.","DOI":"10.3390\/antibiotics14030284"},{"key":"ref_52","unstructured":"Zambia National Public Health Institute (2025, June 17). Zambia\u2019s Integrated Antimicrobial Resistance Surveillance Framework. Available online: https:\/\/www.afro.who.int\/publications\/zambias-integrated-antimicrobial-resistance-surveillance-framework."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1093\/jac\/dky026","article-title":"An inventory of supranational antimicrobial resistance surveillance networks involving low- and middle-income countries since 2000","volume":"73","author":"Ashley","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_54","first-page":"e40779","article-title":"Evaluation of the Antimicrobial Resistance Surveillance System in Sentinel Sites in Cameroon","volume":"15","author":"Yopa","year":"2023","journal-title":"Cureus"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"92","DOI":"10.12688\/wellcomeopenres.12527.1","article-title":"AMR Surveillance in low and middle-income settings\u2014A roadmap for participation in the Global Antimicrobial Surveillance System (GLASS)","volume":"2","author":"Seale","year":"2017","journal-title":"Wellcome Open Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-014-0041-4","article-title":"A review of 40 years of enteric antimicrobial resistance research in Eastern Africa: What can be done better?","volume":"4","author":"Omulo","year":"2015","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Zwane, T., Shuping, L., and Perovic, O. (2021). Etiology and Antimicrobial Susceptibility of Pathogens Associated with Urinary Tract Infections among Women Attending Antenatal Care in Four South African Tertiary-Level Facilities, 2015\u20132019. Antibiotics, 10.","DOI":"10.3390\/antibiotics10060669"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1186\/s12884-021-04142-4","article-title":"Prevalence, antimicrobial susceptibility pattern and associated risk factors for urinary tract infections in pregnant women attending ANC in some integrated health centers in the Buea Health District","volume":"21","author":"Ngong","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s12866-025-03842-7","article-title":"Antimicrobial susceptibility and risk factors of uropathogens in symptomatic urinary tract infection cases at Dessie Referral Hospital, Ethiopia","volume":"25","author":"Kebede","year":"2025","journal-title":"BMC Microbiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3628","DOI":"10.1128\/AAC.00359-13","article-title":"Evaluation of Antimicrobial Susceptibility of Enterobacteriaceae Causing Urinary Tract Infections in Africa","volume":"57","author":"Athanasiou","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/nrmicro3432","article-title":"Urinary tract infections: Epidemiology, mechanisms of infection and treatment options","volume":"13","author":"Walker","year":"2015","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s13756-018-0324-2","article-title":"Multidrug-resistant gram-negative bacterial infections in a teaching hospital in Ghana","volume":"7","author":"Agyepong","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"585","DOI":"10.2147\/IDR.S296054","article-title":"Epidemiology of Community Origin Escherichia coli and Klebsiella pneumoniae Uropathogenic Strains Resistant to Antibiotics in Franceville, Gabon","volume":"14","author":"Richard","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Kot, B., Gru\u017cewska, A., Szweda, P., Wicha, J., and Parulska, U. (2021). Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020. Antibiotics, 10.","DOI":"10.3390\/antibiotics10040447"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"17299","DOI":"10.1038\/s41598-019-53712-2","article-title":"Antimicrobial resistance in pathogenic aerobic bacteria causing surgical site infections in Mbarara regional referral hospital, Southwestern Uganda","volume":"9","author":"Hope","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4103\/JLP.JLP_55_18","article-title":"Characterization and antimicrobial susceptibility of coagulase-negative staphylococci isolated from clinical samples","volume":"10","author":"Bora","year":"2018","journal-title":"J. Lab. Physicians"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Michels, R., Last, K., Becker, S.L., and Papan, C. (2021). Update on Coagulase-Negative Staphylococci\u2014What the Clinician Should Know. Microorganisms, 9.","DOI":"10.3390\/microorganisms9040830"},{"key":"ref_68","first-page":"1073","article-title":"Understanding the Practices and Challenges in Antimicrobial Susceptibility Testing: A Qualitative Study of Medical Laboratory Technicians in Saudi Arabia","volume":"7","author":"Alshammari","year":"2024","journal-title":"J. Int. Crisis Risk Commun. Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1093\/labmed\/lmac090","article-title":"A Literature Review on How We Can Address Medical Laboratory Scientist Staffing Shortages","volume":"54","author":"Halstead","year":"2022","journal-title":"Lab. Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e00960-24","DOI":"10.1128\/jcm.00960-24","article-title":"The foundation for the microbiology laboratory\u2019s essential role in diagnostic stewardship: An ASM Laboratory Practices Subcommittee report","volume":"62","author":"Dumm","year":"2024","journal-title":"J. Clin. Microbiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1017\/ice.2023.5","article-title":"Principles of diagnostic stewardship: A practical guide from the Society for Healthcare Epidemiology of America Diagnostic Stewardship Task Force","volume":"44","author":"Fabre","year":"2023","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1429200","DOI":"10.3389\/fcimb.2024.1429200","article-title":"Molecular mechanisms of resistance to \u201clast resort\u201d antimicrobials in Enterobacterales","volume":"14","author":"Schneiders","year":"2024","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e01142-24","DOI":"10.1128\/spectrum.01142-24","article-title":"Antimicrobial susceptibility to last-resort antibiotics in carbapenemase-producing bacteria from Ukrainian patients","volume":"12","author":"Verkaik","year":"2024","journal-title":"Microbiol. Spectr."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.cmi.2024.02.003","article-title":"WHO\u2019s essential medicines and AWaRe: Recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections","volume":"30","author":"Moja","year":"2024","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"dlaf031","DOI":"10.1093\/jacamr\/dlaf031","article-title":"Increasing the use of the WHO AWaRe system in Antibiotic Surveillance and Stewardship Programs in Low- and Middle-Income Countries","volume":"7","author":"Saleem","year":"2025","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/S1473-3099(19)30532-8","article-title":"Encouraging AWaRe-ness and discouraging inappropriate antibiotic use:\u2014The new 2019 Essential Medicines List becomes a global antibiotic stewardship tool","volume":"19","author":"Sharland","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_77","unstructured":"World Health Organization (2022). The WHO AWaRe (Access, Watch, Reserve) Antibiotic Book, World Health Organization."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"290","DOI":"10.2471\/BLT.22.288614","article-title":"The WHO AWaRe (Access, Watch, Reserve) antibiotic book and prevention of antimicrobial resistance","volume":"101","author":"Zanichelli","year":"2023","journal-title":"Bull. World Health Organ."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.1016\/S0140-6736(24)01019-5","article-title":"Ensuring progress on sustainable access to effective antibiotics at the 2024 UN General Assembly: A target-based approach","volume":"403","author":"Mendelson","year":"2024","journal-title":"Lancet"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Godman, B., Egwuenu, A., Haque, M., Malande, O.O., Schellack, N., Kumar, S., Saleem, Z., Sneddon, J., Hoxha, I., and Islam, S. (2021). Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries. Life, 11.","DOI":"10.3390\/life11060528"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.jiac.2019.10.023","article-title":"Comparison of penicillins (penicillin G and ampicillin) and cefazolin as a definitive therapy against penicillin-susceptible Staphylococcus aureus (PSSA) bacteremia in Japan: A retrospective cohort study","volume":"26","author":"Moriyama","year":"2020","journal-title":"J. Infect. Chemother."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Meesters, K., Alemayehu, T., Benou, S., Buonsenso, D., Decloedt, E.H., Pillay-Fuentes Lorente, V., Downes, K.J., and Allegaert, K. (2023). Pharmacokinetics of Antimicrobials in Children with Emphasis on Challenges Faced by Low and Middle Income Countries, a Clinical Review. Antibiotics, 12.","DOI":"10.3390\/antibiotics12010017"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1093\/cid\/cix961","article-title":"Pharmacokinetics and Pharmacodynamic Target Attainment of Benzylpenicillin in an Adult Severely Ill Sub-Saharan African Patient Population","volume":"66","author":"Bos","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"107192","DOI":"10.1016\/j.ijantimicag.2024.107192","article-title":"Antimicrobial therapeutic drug monitoring in critically ill adult patients\u2014An international perspective on access, utilisation, and barriers","volume":"64","author":"Williams","year":"2024","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"iv22","DOI":"10.1093\/jac\/dkz284","article-title":"Trends in antimicrobial resistance over 10 years among key bacterial pathogens from Canadian hospitals: Results of the CANWARD study 2007\u201316","volume":"74","author":"Adam","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"3045","DOI":"10.1093\/jac\/dkab300","article-title":"Impact of the COVID-19 pandemic on the surveillance, prevention and control of antimicrobial resistance: A global survey","volume":"76","author":"Tomczyk","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_87","unstructured":"Hindler, J.F., Simner, P.J., Abbott, A., Benahmed, F.H., Bhowmick, T., Das, S., Erdman, S.M., Ferrell, A.L., Johnson, K., and Lubbers, B.V. (2022). Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data, Clinical and Laboratory Standards Institute."},{"key":"ref_88","unstructured":"Centres for Disease Control & Prevention (2019). National Healthcare Safety Network (NHSN) Patient Safety Component Manual, Centres for Disease Control & Prevention."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"e0190132","DOI":"10.1371\/journal.pone.0190132","article-title":"Implementation of global antimicrobial resistance surveillance system (GLASS) in patients with bacteremia","volume":"13","author":"Sirijatuphat","year":"2018","journal-title":"PLoS ONE"},{"key":"ref_91","unstructured":"World Health Organization (2003). Manual for Laboratory Diagnosis of Bacterial Infections in Humans: Enterobacteriaceae and Other Gram-Negative Rods, WHO."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1128\/CMR.18.1.147-162.2005","article-title":"Manual and Automated Instrumentation for Identification of Enterobacteriaceae and Other Aerobic Gram-Negative Bacilli","volume":"18","year":"2005","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/JCM.00213-21","article-title":"Overview of Changes to the Clinical and Laboratory Standards Institute, Performance Standards for Antimicrobial Susceptibility Testing, M100, 31st Edition","volume":"59","author":"Humphries","year":"2021","journal-title":"J. Clin. Microbiol."},{"key":"ref_94","unstructured":"World Health Organization (2015). Global Antimicrobial Resistance Surveillance System, WHO."},{"key":"ref_95","unstructured":"Clinical and Laboratory Standards Institute (2023). Performance Standards for Antimicrobial Susceptibility Testing. CLSI Supplement M100, Clinical and Laboratory Standards Institute (CLSI). [33rd ed.]."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/11\/1136\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T05:22:51Z","timestamp":1762924971000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/11\/1136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,10]]},"references-count":95,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["antibiotics14111136"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14111136","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,10]]}}}