You-Hee Cho ¹ Miklos Fuzi ² Yuji Morita ³ Rustam Aminov ^4*

• ¹ Department of Pharmacy, College of Pharmacy, CHA University, Pocheon-si, Gyeonggi, Republic of Korea
• ² Independent researcher, Seattle, United States
• ³ Department of Infection Control Science, Meiji Pharmaceutical University, Tokyo, Japan
• ⁴ The School of Medicine, Medical Sciences, and Nutrition, University of Aberdeen, Aberdeen, United Kingdom

At the same 1me, the majority of prescrip1ons for bacterial infec1ons are usually empirical because of the need to start the therapy as soon as possible and also for 1me and cost considera1ons associated with determining an1bio1c resistance profile of a suspected bacterial pathogen. In this regard, the knowledge about the epidemiology of AMR among various pathogens in a given geographical area is important for empirical prescrip1ons. Almutairy summarised the current data on the epidemiology of extensively drug-resistant (XDR) and MDR bacterial strains in Saudi Arabia and some other geographical areas in the Middle East and Asia, for which the knowledge about epidemiology of AMR remains insufficient.Factors that exert influence on differen1al epidemiology of AMR in various geographical loca1ons/ countries is also one of the priority areas of research. Choudhury and coauthors inves1gated the occurrence and dynamic of fluoroquinolone-resistant Escherichia coli (FQREC) in the USA and Iraq. In the laRer country, an1bio1cs are frequently dispensed without prescrip1on, and this study inves1gated the impact of different an1bio1c use prac1ces on the epidemiology of FQREC. In Iraq, resistance to all tested an1bio1cs was significantly higher, with 76.2% being FQREC, versus 31.2% in the USA. Moreover, a significant difference in the clonal affilia1on of the FQREC strains was also detected, with some minor clones of MDR strains more prominent in Iraq, while ST1193 isolates were encountered in the United States but not in Iraq.There are also concerns that the widespread use of ca1onic biocides (CBs) in clinical, food chain and diverse environmental sepngs may contribute to the emergence of resistance to both biocides and an1bio1cs. Pereira and others provided a comprehensive narra1ve review summarising the responses of Enterococcus spp. to CBs and possible emergence of co-and cross-resistance between CBs and an1bio1cs. The authors iden1fied considerable methodological and knowledge gaps and highlighted the areas of future research for beRer understanding the epidemiology of Enterococcus spp. popula1ons subjected to the CBs exposure.With the global rise of AMR in different pathogens, the search for alterna1ve treatment of infec1ons remains one of the intensively developing areas of research. This can be demonstrated by the renewed interest in phage therapy, which, however, has certain limita1ons such as the efficacy of phages against biofilms and the development of phage resistance. To address this problem, Benavente and coauthors introduced an evolu1onary approach to enhance the ac1vity of Staphylococcus aureus phages against biofilms. They used pre-stablished biofilms and real-1me isothermal microcalorimetry monitoring in a serial-passage assay to obtain phages ac1ve against S. aureus biofilms. The phages selected demonstrated an expanded host range and higher efficacy. Thus, this approach has the poten1al to improve the phage therapy of biofilm-associated infec1ons, reducing the probability of phage resistance and lessening the risk of infec1on relapse.Among other an1bio1c alterna1ves, the use of silver nanopar1cles (AgNPs) have aRracted considerable aRen1on due to their broad-spectrum biocidal ac1vi1es against bacteria, fungi, and viruses. The mechanisms of AgNPs ac1vi1es are implemented via the genera1on of oxygen-reac1ve species, damage to DNA, rupture of bacterial cell membranes, and inhibi1on of protein synthesis. Rodrigues and others summarised recent advances in this area, with the emphasis on proteomic mechanisms of an1microbial effects of AgNPs, and how these mechanisms affect bacteria in planktonic and biofilm forms.Many bacterial pathogens are capable of forming persister cells, with decreased metabolic ac1vi1es, which significantly reduces the suscep1bility to an1bio1cs and, therefore, efficacy of an1bacterial therapy. Zhu and coauthors inves1gated the effect of the Enterococcus faecalis pheromone, cCF10, on the forma1on of biofilms and genera1on of persister cells. Addi1on of cCF10 blocked persister cell forma1on via metabolic mechanisms rather than inhibi1on of biofilm forma1on. The pheromone s1mulated the Opp system and entered bacterial cells, inhibi1ng (p)ppGpp accumula1on and maintaining the metabolically ac1ve state thus reducing persister cell forma1on.In the annual edi1on of Insights in An1microbials, Resistance and Chemotherapy", we summarise ar1cles that explore innova1ve approaches needed in an1microbial stewardship and rapid detec1on, epidemiology and treatment of AMR. The 2023 edi1on included seven ar1cles covering rapid detec1on of AMR in M. tuberculosis, epidemiology of AMR and factors such as prescrip1on prac1ces and the use of CBs that may contribute to the spread of AMR, and alterna1ves to an1microbials such as phages, AgNPs, and pheromones that may help to cope with the rise of AMR. We hope that our readers would find the ar1cles in this topic useful for their research, teaching, and public engagement.