The Emerging Resistance Index: tracking early resistance to new antibiotics - 07/10/25

Doi : 10.1016/S1473-3099(25)00501-8

Jacopo Garlasco, MD ^a,^{^{†
Contributed equally}}, Fabiana Arieti, PhD ^a,^{^{†
Contributed equally}}, Matteo Morra, MD ^a, Maela Tebon, PhD ^a, Diego Ortiz, MSc ^b, Maria Diletta Pezzani, MD ^a, Karin Odoj, PhD ^b, Federica Manco, MSc ^a, Alessandro Cassini, PhD ^c, Stephan Harbarth, ProfMD ^d, Elisabeth Presterl, ProfMD ^e, Biljana Carevic, PhD ^f, Gunnar Kahlmeter, ProfMD ^h, Karin Thursky, ProfMD ⁱ, Paola Morelli, PhD ^g, Stefan Hagel, MD ^j, Alessia Savoldi, PhD ^a,^{^{†
Contributed equally}}, Evelina Tacconelli, ProfPhD ^a,^{^{†
Contributed equally},}⁎
^a Department of Diagnostics and Public Health, Infectious Diseases Division, University of Verona, Verona, Italy
^b Department of Internal Medicine I, Section of Infectious Diseases, University Hospital Tübingen, Tübingen, Germany
^c Cantonal Office of Health, Geneva, Switzerland
^d Infection Control Program and WHO Collaborating Center, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
^e Department of Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
^f Special Advisor for Infection Prevention and Control, Oslo University Hospital, Oslo, Norway
^g Infectious Diseases Unit, Humanitas Research Hospital, Milan, Italy
^h Department of Clinical Microbiology, Central Hospital, Växjö, Sweden
ⁱ National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
^j Institute for Infectious Diseases and Infection Control, Jena University Hospital-Friedrich Schiller University, Jena, Germany

^*Correspondence to: Prof Evelina Tacconelli, Department of Diagnostics and Public Health, Infectious Diseases Division, University of Verona, 37134 Verona, ItalyDepartment of Diagnostics and Public HealthInfectious Diseases DivisionUniversity of VeronaVerona37134Italy

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 07 October 2025

Summary

The high clinical burden of antimicrobial resistance (AMR) and the dwindling antibiotic pipeline demand standardised tools to monitor resistance development to new antibiotics. The Emerging Resistance Index (ERI) is a novel quantitative tool designed to track resistance to newly developed antibiotics. The ERI incorporates various parameters: AMR pooled proportions and trends, availability of AMR and antimicrobial consumption surveillance systems, time lag between antibiotic approval and resistance detection, and the average annual number of outbreaks caused by resistant strains. AMR and antimicrobial consumption data on 13 new antibiotics were extracted by reviewing the literature and the reports from 38 surveillance systems included in the European Clinical Research Alliance on Infectious Diseases–The Epidemiology Network central data repository, encompassing 27 EU countries, four European Free Trade Association countries, and the UK. Our analysis revealed rapid resistance development to all new Gram-negative-targeting antibiotics, with particularly high ERI values for imipenem–relebactam and cefiderocol. Combinations of old β-lactams with novel inhibitors were especially prone to rapid resistance development. The ERI could offer a quantitative and dynamic tool for monitoring resistance trends. Also, the ERI could support more timely surveillance efforts, inform antibiotic policy decisions, and aid in prioritising antibiotic research and development.

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