Data on cefiderocol resistance in West Africa, particularly among NDM-producing Gram-negative bacilli

The gap

Evidence profile

Sourced from the future work and stated research gap of the source papers, classified as general, drawn from work published between 2024 and 2026, spanning 4 journals. Those papers have been cited 11 times in total.

Supporting evidence — 4 representative gaps

• Fosfomycin Resistance in Escherichia coli: Mechanisms, Trends, and Clinical Challenges (2026) · Cureus · doi

  Fosfomycin-resistant E. coli infections are on the rise, which emphasizes the necessity of ongoing research and the creation of practical solutions to maintain fosfomycin’s clinical usefulness. The molecular epidemiology of resistance genes, particularly plasmid-mediated determinants like fosA3, and their function in the spread of MDR strains should be the main focus of future research. In both hospital and community settings, WGS and advanced genomic surveillance may aid in the early identification and tracking of resistant clones [16]. Accurate diagnosis of fosfomycin resistance and prompt therapeutic decision-making depend on the development of quick molecular diagnostic approaches and uniform susceptibility testing procedures. Affordable molecular assays for rapid detection of fosA3 and other transferable resistance determinants remain limited in many resource-constrained settings and should be prioritized to improve early detection and surveillance of fosfomycin resistance. Additionally, investigating fosfomycin-based combination therapies against carbapenem-resistant and ESBL-producing E. coli may enhance treatment results and lessen the emergence of resistance during therapy [7]. Future goals should include bolstering antimicrobial stewardship initiatives, encouraging sensible antibiotic usage, and carrying out multicentric surveillance investigations, especially in emerging nations like India. To maximize fosfomycin’s therapeutic function against resistant Gram-negative organisms, more clinical trials assessing the drug’s effectiveness and safety in severe systemic infections are required [5].

  generalfuture work
  Keywords: fosfomycin resistance resistant molecular surveillance coli infections clinical determinants like fosa function future settings early
• Carbapenem-resistant Gram-negative pathogens: molecular epidemiology, diagnostic advances, and emerging therapeutic strategies (2026) · Frontiers in Microbiology · doi

  Despite major advances in diagnostics and therapeutics, CR-GNPs remain a significant global health threat because of the continued emergence of resistance mechanisms and high- risk clones. Future control strategies will rely on genomic surveillance, precision diagnostics, AI-assisted clinical decision support, antimicrobial stewardship, and One Health interventions. 6.1 Expansion of genomic surveillance programs Routine implementation of WGS is expected to transform CR- GNP surveillance by enabling comprehensive characterization of resistance determinants, virulence factors, mobile genetic elements, and transmission pathways. Real-time genomic surveillance will facilitate early detection of emerging carbapenemase variants, track the spread of high-risk clones and assist with infection prevention. Integration of genomic data into national and international surveillance networks will strengthen monitoring of resistance dissemination and the emergence of hybrid resistance– virulence plasmids across healthcare, community, animal, and environmental settings (McArthur and Tsang, 2017). 6.2 Precision diagnostics and rapid resistance prediction Current diagnostic approaches for CR-GNPs remain limited by turnaround time, cost, and incomplete characterization of resistance mechanisms. Future precision diagnostics integrating nanopore sequencing, metagenomics, CRISPR-based assays, and multiplex molecular platforms are expected to enable rapid detection of pathogens and resistance determinants directly from clinical specimens. Expanding access to affordable point- of-care (POC) molecular diagnostics, particularly in low- and middle-income countries, will improve timely diagnosis, optimize antimicrobial therapy, and strengthen antimicrobial stewardship (Elbehiry and Abalkhail, 2025). 6.3 AI and digital microbiology role Artificial intelligence is expected to play an increasingly important integrating in CR-GNP management by microbiological, genomic, epidemiological, and clinical data for resistance prediction, therapeutic guidance, and outbreak surveillance. Successful implementation will require standardized datasets, robust model validation, transparent algorithms, and appropriate regulatory oversight (Peiffer-Smadja et al., 2020). 6.4 Novel therapeutic approaches Novel BL/BLI combinations have expanded treatment options for CR-GNP infections; however, resistance to these agents is increasingly being reported. Continued investment in innovative therapeutics remains essential. Promising future therapeutic strategies include: • Next-generation β-lactamase inhibitors active against MBLs • Improved siderophore antibiotics • Bacteriophage therapy • Antimicrobial peptides • Anti-virulence compounds • Monoclonal antibody-based therapies • Host-directed immunomodulatory approaches

  generalfuture work
  Keywords: resistance surveillance diagnostics genomic antimicrobial future precision clinical expected virulence approaches therapeutic therapeutics gnps remain
• Carbapenem-Resistant Enterobacterales in the Western Balkans: Addressing Gaps in European AMR Surveillance Map (2024) · Antibiotics · cited 11× · doi

  Despite the obvious improvement of the CAESAR data for the WB countries over the years, there are significant data gaps. The overall number of isolates per country is low to medium, which is in accordance with the paucity of studies into CRE from Antibiotics 2024, 13, 895 12 of 15 these countries. A limited availability of resources, such as modern equipment or train- ing, particularly for genomic analysis, significantly contributes to the small quantity of research conducted. Serbia could be an exception and a good example, as several genomic- based studies contributed to a growing understanding of AMR in this country. The most concerning results were a detection of the new plasmid p101_srb, harboring OXA-48 car- bapenemase in K. pneumoniae isolates from humans and wastewater samples, as well as the detection of the mcr-9 gene in K. pneumoniae and E. cloacae complex strains, also from different sources. These results suggest a possible interchange of resistant determinants in bacteria over time and through different niches and emphasize the need for an in-depth retrospective genomic analysis to gain a better insight into AMR spreading. While these results stem from individual projects, there is a pressing need for increased national support for microbiology laboratories. Author Contributions: Conceptualization, I.C.; electronic database search, article screening, data abstraction, and analysis, S.B. and I.C.; figure design, S.B. and I.C.; writing—original draft preparation, S.B.; writing—review and editing, I.C. and S.B. All authors have read and agreed to the published version of the manuscript. Funding: This research was funded by the Ministry of Science, Technological Development and Innovation, the Republic of Serbia, grant number 451-03-65/2024-03/200110. Institutional Review Board Statement: Not applicable. Informed Consent Statement: Not applicable. Data Availability Statement: Not applicable. Conflicts of Interest: The authors declare no conflicts of interest.

  generalfuture work
  Keywords: genomic statement applicable countries there number isolates country availability serbia detection pneumoniae different need writing
• NDM‑mediated cefiderocol resistance among a series of carbapenem‑resistant Gram‑negative bacilli isolates in Niger (2026) · F1000Research · doi

  There is a lack of data on cefiderocol resistance in West Africa, particularly among NDM-producing Gram-negative bacilli. The study aims to address this knowledge gap by characterizing cefiderocol-resistant isolates and detecting carbapenemase genes. The research seeks to understand the mechanisms of cefiderocol resistance and its implications for public health.

  generalstated research gapevidence 5/5
  Keywords: there lack data cefiderocol resistance west africa particularly

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