Pathogens
The Resistance Constellation Across the Sepsis-Uropathogen Continuum: A Thirteen-Year Atlas of Epidemiological Expansion, Resistance Kinetics, and Progressive Therapeutic Attrition
By Uppal MR, Saeed U, Uppal R and 5 others.
Abstract
Background
Conventional antibiograms compress antimicrobial resistance (AMR) into static percentages, obscuring whether therapeutic space is being lost gradually in high-burden pathogens or rapidly in less prevalent but increasingly resistant organisms. We developed a multidimensional longitudinal framework to map the evolving "resistance architecture" of bloodstream and urinary pathogens by integrating pathogen burden, demographic redistribution, specimen compartment, resistance velocity, and remaining antimicrobial-class activity.
Methods
This retrospective, multicentre laboratory-surveillance study analysed 39,057 culture records collected through a multi-regional network from 2013 to 2025, comprising 4800 bloodstream and 34,257 urinary records. Three surveillance periods were compared: 2013-2017, 2018-2020, and 2021-2025. Analyses included temporal pathogen composition, demographic gravity, geographic surveillance concentration, compartment enrichment, descriptive Resistance Velocity, and Therapeutic Compression. Therapeutic Compression quantified the proportion of clinically relevant antimicrobial classes with susceptibility below a prespecified 80% threshold; sensitivity analyses were repeated at 70% and 90%. This measure represents microbiologically inferred treatment-space contraction, not patient-level therapeutic failure. Projections to 2030 were treated as exploratory scenarios. The urinary component derives substantially from 2013 to 2025 institutional surveillance resource previously used for a narrower urine-only analysis; overlap, counting units, and analytical distinctions are explicitly disclosed in the Methods.