Antimicrobial Resistance in Healthcare-Associated Infections

Healthcare-associated infections (HAIs) represent a major threat to patient safety worldwide, driven by the increasing prevalence of antimicrobial resistance (AMR) among nosocomial pathogens. Invasive procedures, prolonged hospitalisation and immunocompromised hosts provide ample opportunity for opportunistic bacteria and fungi to establish infections that defy standard treatment. Resistance mechanisms—ranging from production of extended-spectrum β-lactamases and carbapenemases to target-modifying methylases and efflux pumps—have evolved rapidly under selective pressure from broad-spectrum antibiotic use. Transmission occurs via direct patient contact, contaminated surfaces and medical devices, as well as through environmental reservoirs such as wastewater. The global burden of AMR in HAIs has prompted intensified research into molecular epidemiology, novel antimicrobial development, diagnostic stewardship and infection-control strategies. Progress in real-time genomic surveillance and precision antibiograms is informing local stewardship policies, while innovations in anti-virulence agents and bacteriophage therapy offer potential future interventions. Collective efforts that integrate clinical practice, microbiological surveillance and environmental management are essential to curb the spread of multidrug-resistant organisms in healthcare settings.

Research from Nature Portfolio

Recent high-resolution sequencing studies have delineated the silent carriage and intra-unit spread of carbapenem-resistant Enterobacterales in intensive care environments, identifying both patient and environmental hotspots that had previously gone undetected. Parallel investigations into hospital wastewater have uncovered novel plasmid-borne colistin resistance genes, emphasising the role of effluent treatment in interrupting gene flow back into clinical and community settings. At the molecular level, metagenome-based analyses of respiratory and bloodstream isolates have revealed co-selection of extended-spectrum β-lactamase and 16S rRNA methylase determinants within single Pseudomonas aeruginosa clones, underlining the complexity of resistance cassettes that compromise last-line treatments. Together, these findings demonstrate the power of combining genomic epidemiology with environmental surveillance to map transmission networks and to inform targeted interventions in high-risk units.

Antimicrobial Resistance in Healthcare-Associated Infections publication trend

The graph below shows the total number of articles in antimicrobial resistance in healthcare-associated infections across all publications each year (not limited to Nature Index journals).

Technical terms

Antimicrobial Resistance (AMR): The capacity of microorganisms to survive or proliferate despite exposure to drugs designed to inhibit or kill them.

Healthcare-Associated Infection (HAI): An infection acquired during or following a stay in a healthcare facility, not present at admission.

Antibiogram: A compiled summary of antimicrobial susceptibility patterns of local microbial isolates, used to guide empiric therapy choices.

Plasmid-mediated Resistance: The spread of resistance genes through extrachromosomal DNA elements (plasmids), facilitating horizontal transfer among bacterial species.

References

1. Deficiencies of Rule-Based Technology-Generated Antibiograms for Specialized Care Units. Antibiotics (2023).
2. Comparing automated surveillance systems for detection of pathogen-related clusters in healthcare settings. Antimicrobial Resistance & Infection Control (2024).
3. Detection of Temporal Clusters of Healthcare-Associated Infections or Colonizations with Pseudomonas aeruginosa in Two Hospitals: Comparison of SaTScan and WHONET Software Packages. PLOS ONE (2015).