Dalal Hammoudi Halat ^1* Issmat I. Kassem ² Marwan Osman ³ Vera Manageiro ⁴

• ¹ Academic Quality Department, QU Health, Qatar University, Doha, Qatar
• ² Department of Food Science and Technology, Center for Food Safety, University of Georgia, Griffin, University of Georgia, Athens, Georgia, United States
• ³ Department of Neurosurgery, School of Medicine, Yale University, New Haven, Connecticut, United States
• ⁴ National Reference Laboratory of Antibiotic Resistances and Healthcare-Associated Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal, Lisbon, Portugal

The World Antimicrobial Awareness Week (WAAW), established at the 68 th World Health Assembly in 2015 and observed from the 18 th to the 24 th of November each year, has been an annual occasion to direct public attention to the overwhelming burden of antimicrobial resistance (AMR).The key aim of this event is to improve awareness to AMR, highlighting the importance of education and communication. In 2023, the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Program (UNEP), the World Health Organization (WHO), and the World Organization for Animal Health (WOAH) announced the rebranding of WAAW as the World AMR Awareness Week. These changes aimed at better supporting the challenges of AMR (1). A breakthrough in bacterial AMR epidemiology were the comprehensive analyses of the global burden through 2050 (2). These studies highlighted a concerning increase in resistance to critically important antimicrobials, particularly carbapenem-resistant Gram-negative bacteria and multidrug-resistant Mycobacterium tuberculosis. Alarmingly, bacterial infections were estimated to contribute to ~5 million deaths annually, with approximately 1.2 million directly attributed to AMR (2). Efforts to prevent AMR must remain a top priority for global health stakeholders, because AMR represents one of the top critical challenges of the 21st century, particularly in low-resource settings and conflictaffected regions (3). Strengthening surveillance systems is essential to track resistance patterns, identify emerging threats, and guide evidence-based targeted interventions. Equally important is fostering awareness among healthcare providers, policymakers, and the broader community about the Across the world, countries have been encouraged to develop national plans to mitigate AMR (4). In this regard, surveillance systems have been considered vital to monitor AMR trends, evaluate effects of various interventions, and inform decision making by stakeholders (5). In this Research Topic, the United Arab Emirates (UAE) AMR Surveillance Consortium's contributions demonstrated how integrated surveillance systems can track resistance in pathogens like methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, vancomycin-resistant enterococci, Acinetobacter species, Pseudomonas aeruginosa, carbapenem-resistant Enterobacterales as well as Mycobacterium tuberculosis. Indeed, Thomsen and Colleagues described a broad network of over 300 surveillance centers. Furthermore, the Consortium presented trends of resistance in the UAE over 12 years for 7 different bacterial pathogens, leveraging a unified application for the management and analysis of microbiology laboratory data with a particular focus on AMR surveillance. This application was developed and supported by the WHO Collaborating Centre for Surveillance of AMR. The investigations called for further epidemiological enquiry and monitoring of genetic evolution in these pathogens to provide new strategies for prevention and control. Also, a retrospective 3-year study of highly resistant Candida auris in the UAE is presented, calling for enhanced infection control measures to prevent continued dissemination of this urgent threat pathogen that is characterized by high mortality and persistent transmissions in healthcare settings. The rising incidence and burden of fungal infections was also highlighted by Husni and Colleagues in a multicenter study from Lebanon, uncovering significant increase in non-albicans Candida species with high resistance profiles, amidst lack of local treatment guidelines. Consequently, the researchers called for establishment of guidelines to decrease morbidity and mortality as well as for continuous collection of surveillance data. Also within the debilitated healthcare system in Lebanon, Daaboul and Colleagues described broad dissemination of blaNDM-5 and blaOXA-244 genes among carbapenem-resistant Enterobacterales in the Lebanese clinical settings, underscoring an urgent necessity for transformative methods to combat AMR in both community and hospital environments. The pursuit of novel antimicrobial alternatives is critical considering the limited antimicrobial pipelines. Carbapenem-resistant Gram-negative bacteria are especially worrisome in intensive care units (ICU), as accurately revised by Li and Colleagues, making it crucial to increase vigilance against these pathogens during ICU stay, administer antimicrobials rationally based on the pathogen type and susceptibility, and identify carbapenemase types to prevent and control associated infections. Furthermore, a multicenter, retrospective observational study from China by Xiao and Colleagues described bloodstream infections associated with P. aeruginosa, showing increased trends in AMR and higher healthcare costs. A prediction model proposed by Sun and Colleagues identified age, hypoproteinemia, daily dose, medication within 14 days prior to surgical intervention, and microbial clearance as significant risk factors for failure of tigecycline therapy of ventilatorassociated pneumonia caused by carbapenem-resistant A. baumannii . All these studies emphasized the importance of targeted, evidence-based treatment strategies to improve patient outcomes while curbing drug resistance. AMR nowadays cannot be confronted without considering the interconnectedness between human, animal, and environmental dimensions, often collectively referred to as the One Health approach. This is the collaborative effort of multiple health science professionals to attain optimal health for humans, animals, wildlife, plants, and the environment (6). Such interconnected domains, if abused, contribute to the emergence, evolution, and dissemination of antibiotic-resistant microorganisms on both local and global scale, posing a significant risk factor for global health (7). In this regard, Habiba and Colleagues reported significant use of colistin in poultry farms in Pakistan, leading to rapid shedding through poultry waste to the environment, ultimately affecting biosecurity. This was accompanied by lack of farmers training and experience with antibiotic use and AMR. In Italy, Salmonella was identified by Petrin and Colleagues in human, animal, and food samples, with numerous AMR genes and plasmid replicons associated with resistance to critical antimicrobials, favoring their successful spread and complicating the problem of AMR further. Taken together, these studies highlighted the transboundary nature of AMR and the necessity of harmonized surveillance across niches, including food and agriculture.. Raising public awareness and addressing cultural issues in mitigating AMR should not be overlooked. In this regard, Waswa and Colleagues described a brief for policymakers about school curricula that advocate for and support integration of AMR content in primary and secondary level grades. The policy brief supports and facilitates efforts by national AMR committees to create more awareness on this issue. Moreover, to highlight tackling AMR in different cultures, Lescure and Colleagues evaluated a communication intervention for general practitioners in multicultural Dutch cities to improve antibiotic prescribing for respiratory tract infections. The intervention proved to be useful and resulted in improvement of self-rated knowledge and learning culturally-sensitive communication skills beneficial to AMR control. As described by Ayorinde and Colleagues in their systematic review on healthcare professionals interactions with patients to discuss AMR, different barriers and facilitators play a role in affecting antimicrobial-associated behaviors by patients, which, if identified and properly addressed, would allow improvement. Taken together, these studies add to the body of evidence investigating and reporting current AMR trends and knowledge and will support ongoing research efforts towards this crucial global health threat. In conclusion, by bridging scientific inquiry with advocacy, this Research Topic contributes to the global effort to address AMR. The findings reflect current challenges as well as the immense potential for progress through shared knowledge and concerted action. The articles in this Research Topic highlight the multifaceted nature of AMR and feature the pivotal role of WAAW in sharing evidence, raising awareness, promoting stewardship, and fostering collaborative efforts to combat AMR. While progress has been made, the road ahead requires a stronger emphasis on innovation and technology-driven solutions to secure sustainable outcomes. In this regard, emerging therapeutic strategies, such as the development of novel antibiotics and alternatives to traditional antimicrobials, must be prioritized. Moreover, machine learning and artificial intelligence offer transformative potential in this domain, enabling rapid identification of new antimicrobial compounds and alternative therapeutics needed to enrich the drug pipeline in the face of increased AMR. Advancements in vaccine development also represent a critical preventative measure, reducing reliance on antibiotics and curbing the spread of resistant infections. Within the framework of WAAW, integrating these scientific advances with public health advocacy is essential. Strengthening the alignment between WAAW objectives and cutting-edge scientific developments will reinforce the global fight against AMR, nurturing a more resilient future for global health systems.