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Antimicrobial ResistanceHealth
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Public note

For situational awareness and research transparency. Not medical advice.

Synthesis · Antimicrobial Resistance

AMR evidence cycle is dry; PubMed stale and multiple connectors at staleness >1.0; two hypotheses approach Apr 27 resolution with no incoming data.

Surveillance of emerging AMR phenotypes, carbapenem-resistant Enterobacterales spread, and novel resistance gene dissemination across healthcare settings.

Updated Apr 22, 2026

Synthesis

DepthL3
L1

Key findings

No AMR-specific evidence ingested this cycle. ECDC EARS-Net last ran Apr 21 (stale); PubMed at 14% ok ratio and timing out; Africa CDC failing. Two short-horizon hypotheses — XDR Shigella proportion (resolves Apr 27) and ceftriaxone-resistant gonorrhea US cluster (resolves Apr 27) — are approaching resolution with no evidence to inform them. C. auris expansion (conf 7) and hospital-onset AMR persistence above baseline (conf 7) remain the primary high-conviction bets pending CDC annual reporting.

L2

Technical analysis

ECDC EARS-Net (last run Apr 21, staleness ratio 1.168) provided a generic scientific publications list — no specific AMR resistance rate data. CDC MMWR returned off-topic content (kratom, childhood vaccination). ProMED items were also off-topic (foodborne illness Vietnam). GLASS, NCBI-AMR, and PAHO are all stale at staleness >1.0. Africa CDC is failing (pending). WHO DON returned no items.

This is the weakest coverage cycle since scope launch. The absence of PubMed content (0 items, timeout errors) is especially impactful for AMR which depends heavily on literature for novel resistance gene signals.

Apr 27 resolutions are watch items. Both hyp:amr:2026-12-31:aabba5bd33 (XDR Shigella proportion) and hyp:amr:2027-06-30:6bf8ee55bf (ceftriaxone-resistant gonorrhea cluster) resolve Apr 27. These were created Apr 20 with 7-day horizons — likely designed to be resolved by PulseNet or MMWR data that has not arrived in the evidence stream. If no data arrives before Apr 27, resolution will default to ambiguous/no-data.

L3

Full appendix

C. auris expansion (hyp:amr:2026-12-31:5145e6c67c, conf 7): CDC trajectory from 7,700+ cases through 2025 toward ≥12,000 by end 2026. No new CDC data this cycle. Annual AR Threats Report timing is the key resolution pathway.

Hospital-onset AMR above 2019 baseline (hyp:amr:2026-12-31:ca0f555387, conf 7): CDC 2026 AR Threats Report (electronic release) is the resolution event. No indication of release date.

XDR Shigella proportion (hyp:amr:2026-12-31:aabba5bd33, conf 5): Resolves Apr 27. LA novel XDR S. sonnei strain (CIDRAP Jan 2026) is the key event. PulseNet 2024-2026 data has not entered the evidence stream.

Ceftriaxone-resistant gonorrhea (hyp:amr:2027-06-30:6bf8ee55bf, conf 5): Resolves Apr 27. No US cluster report visible in any connector output.

ARG neonatal vertical transfer (hyp:amr:2027-12-31:d09a68ed8d, conf 4): Long-horizon research hypothesis. No prospective cohort study published in this cycle.

XDR Shigella nosocomial (hyp:amr:2026-12-31:f939aac224, conf 4): No healthcare-associated cluster report this cycle.

Calibration note: Mid-confidence accuracy is 0.0 (2 resolved), indicating possible systematic overconfidence in 4-6 range for this scope. Consider downward pressure on new mid-confidence AMR hypotheses.

02

Scope signals

Confidence updates contributing to this scope, and the coverage health of the sources backing them.

Confidence updates

HypothesisPriorDirectionMagnitudeReasoning
XDR Shigella will be documented causing nosocomial or healthcare-associated transmission in immunocompromised patient wards (oncology, HIV, transplant) in at least one US academic medical center by end 2026, establishing a new healthcare transmission pathway distinct from the MSM sexual network4neutral0.05No nosocomial XDR Shigella report this cycle
XDR Shigella (resistant to azithromycin + fluoroquinolones + 3GC simultaneously) proportion in PulseNet US surveillance will exceed 10% of submitted isolates by end of 2026, up from 8.5% in 2023 (MMWR mm7513a1 data endpoint). CIDRAP Jan 14 2026 reported "novel XDR Shigella strain identified in Los Angeles" — the only confirmed 2026 XDR Shigella signal. MMWR 2011-2023 trend shows acceleration: 0% pre-2016 → 8.5% by 2023, with 84% of XDR cases in 2022-2023.5neutral0.05Resolves Apr 27; no PulseNet data in evidence stream
At least one US cluster (≥5 epidemiologically linked cases) of ceftriaxone-resistant Neisseria gonorrhoeae will be confirmed via CDC GISP/ARLN by mid-2027, prompting updated STI treatment guidelines. WHO Nov 2025 warned of "rising, worrisome levels" globally; Healio/CIDRAP Dec 2025 confirmed global surge; FDA approved first new gonorrhoea treatment (zoliflodacin) Dec 2025 specifically because of resistance trajectory.5neutral0.05Resolves Apr 27; no US gonorrhea cluster data
Candida auris clinical cases reported to CDC will exceed 12,000 cumulative by end of 2026 (from 7,700+ confirmed Jan 2026), with echinocandin resistance proportion exceeding 5% nationally. CDC Feb 2026 study confirms "substantial antifungal resistance"; C. auris spreading through NY/NJ/MI hospital networks (CBS Jan 2026, MLive Dec 2025).7neutral0.05No new CDC C. auris data this cycle
At least one prospective cohort study will document ARG vertical transfer from mother to neonate as a measurable predictor of neonatal treatment outcomes, demonstrating that community AMR carriage surveillance systematically underestimates baseline population ARG burden4neutral0.05No prospective ARG cohort study published

Coverage

No coverage table published.