Evidence map›Paper›PMID 40032082›Full record

ArticleClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases2025

Using a difficult-to-treat resistance index to gauge imbalance between countries' antibiotic resistance prevalence and access to antibiotics: a scoping review and concept proposal.

Morgan K Walker, Emad A Chishti, Christina Yek, Sadia Sarzynski, Sahil Angelo, Jennifer Cohn, Alicia A Livinski, Sameer S Kadri

Abstract readScoping Review
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Morgan K WalkerClinical Epidemiology Section, Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
Emad A ChishtiClinical Epidemiology Section, Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
Christina YekClinical Epidemiology Section, Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA; International Center of Excellence in Research Cambodia, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia.
Sadia SarzynskiClinical Epidemiology Section, Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
Sahil AngeloDivision of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Jennifer CohnGlobal Antibiotic Research and Development Partnership, Geneva, Switzerland.
Alicia A LivinskiNational Institutes of Health Library, Office of Research Services, Office of the Director (OD), National Institutes of Health, Bethesda, MD, USA.
Sameer S KadriClinical Epidemiology Section, Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, USA; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA. Electronic address: sameer.kadri@nih.gov.

Funding

Big Data- Epidemiology of Antimicrobial ResistanceZIACL090046 · CLC · CLINICAL CENTER · PI KADRI, SAMEER · 2017 to 2025
$0k
Intramural NIH HHS ZIA CL090046
6 · The paper itself

Abstract

backgroundInferring the impact of antimicrobial resistance on patient outcomes is challenging, given the variability in antibiotic access across countries and over time. By denoting resistance to all highly safe and effective antibiotics, the difficult-to-treat resistance (DTR) definition offers a framework for such assessments globally.

objectivesThis study aims to conduct a scoping review to understand the international adoption, scalability, and prognostic utility of DTR and enable solutions to incorporate antibiotic access into the DTR framework.

methodsData sources: Data sources included Agricola, Embase, Global Index Medicus, PubMed, Scopus, Web of Science: BIOSIS and Core Collection. STUDY ELIGIBILITY CRITERIA: Study eligibility criteria included original research publications occurring after January 2018 using the term 'difficult-to-treat resistance' to describe antimicrobial-resistant bacterial isolates demonstrating resistance to all first-line antibiotics (i.e. all β-lactam and fluoroquinolone antibiotics). ASSESSMENT OF RISK OF BIAS: Assessment of risk of bias included Joanna Briggs Institute critical appraisal tool. METHODS OF DATA SYNTHESIS: We assessed the overall themes of the included studies and classified them into epidemiological, mortality, or antibiotic effectiveness/efficacy studies. Semiquantitative results among studies evaluating the prevalence of resistant bacterial isolates and mortality were reported. We propose a 'DTR index' (DTRi) that extends beyond gram-negative bacteria and complements DTR by estimating national proportions of bacterial isolates resistant to all first-line antibiotics available specifically in that country.

resultsDTR was utilized in 57 studies spanning 94 countries. The DTR definition was predominantly applied unmodified and retained prognostic utility in 70% of studies. The variability in access to first-line antibiotics and emergence of newer agents across countries and over time influence practical treatment options that cannot be captured by 'fixed' DTR definitions underscoring the value of the proposed DTRi.

conclusionsThe DTRi could appraise the clinical impact of introducing new agents in a country, identify hot zones of resistance-access imbalance, and optimize resource allocation to improve antibiotic resistance outcomes, especially in under-resourced populations.

Indexed as

Anti-Bacterial AgentsBacterial InfectionsDrug Resistance, BacterialBacteriaGlobal HealthHumansPrevalenceAnti-Bacterial AgentsAntibiotic accessAntibiotic resistanceClinical epidemiologyDifficult-to-treat resistanceDifficult-to-treat resistance index

Identifiers

PMID40032082
PMCPMC12167685

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.