Antimicrobial resistance (AMR) has emerged as a major global public health threat, particularly in community-acquired infections (CAIs) which account for a substantial proportion of global infectious disease burden. This study aimed to investigate the prevalence of AMR in common CAIs (urinary tract infections, respiratory tract infections, and skin and soft tissue infections), identify key risk factors associated with AMR development, and propose targeted mitigation strategies. A cross-sectional study was conducted across 15 communities in 5 countries (Canada, Japan, India, Spain, Brazil) from January 2022 to December 2023, involving 4,216 patients with confirmed CAIs and 512 community healthcare providers. Microbiological testing, questionnaire surveys, and in-depth interviews were employed to collect data. The results showed that the overall prevalence of AMR in CAIs was 38.7%, with the highest rate in urinary tract infections (45.2%) followed by respiratory tract infections (36.8%) and skin and soft tissue infections (31.5%). Key risk factors included inappropriate antimicrobial use, prior antimicrobial exposure within 6 months, comorbidities (diabetes, chronic respiratory diseases), and poor infection control practices in community healthcare settings. Based on these findings, a multi-layered mitigation framework was proposed, encompassing antimicrobial stewardship in community settings, public health education, strengthening of diagnostic capacity, and intersectoral collaboration. This study provides critical insights into the AMR landscape in CAIs and offers actionable strategies for mitigating the AMR crisis at the community level, which is essential for safeguarding global public health security.

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The COVID-19 pandemic has exposed significant deficiencies in global community infectious disease prevention and control systems. In the post-pandemic era, optimizing community-level prevention and control mechanisms has become a top priority for public health governance. This study adopted a mixed-methods approach, integrating quantitative surveys and qualitative interviews to investigate the operation status, existing problems, and optimization needs of community infectious disease prevention and control systems in 12 cities across 5 countries. A total of 3,620 community residents and 482 public health workers were surveyed, and 60 in-depth interviews were conducted with community managers and medical staff. The results showed that the main challenges faced by community prevention and control systems included insufficient professional staffing, inadequate resource allocation, weak public health awareness among residents, and poor coordination between multiple departments. Based on the results, this study proposed a multi-dimensional optimization framework covering organizational structure, resource allocation, service supply, and public participation. Practical verification in 4 pilot communities confirmed that the optimized system significantly improved the efficiency of infectious disease monitoring, early warning, and response. This study provides important theoretical and practical references for strengthening community public health capacity and building a resilient infectious disease prevention and control system in the post-COVID-19 era.

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Community-acquired skin and soft tissue infections (CA-SSTIs) are among the most common bacterial infections globally, with antimicrobial resistance (AMR) posing a growing threat to treatment efficacy. This study aimed to explore global disparities in AMR prevalence among key pathogens causing CA-SSTIs, identify region-specific risk factors, and evaluate the impact of healthcare system characteristics on AMR trends. A cross-continental observational study was conducted across 20 communities in 5 continents (North America, Asia, Europe, Africa, South America) from March 2022 to March 2024, enrolling 3,842 patients with confirmed CA-SSTIs. Microbiological culture and susceptibility testing, along with structured questionnaires, were used to collect data on pathogen distribution, AMR profiles, patient characteristics, and healthcare access. The overall prevalence of AMR among CA-SSTI pathogens was 34.6%, with significant intercontinental variations: highest in Africa (48.2%) and Asia (43.5%), followed by South America (35.1%), Europe (26.8%), and North America (22.3%). Methicillin-resistantStaphylococcus aureus (MRSA) was the most prevalent resistant pathogen globally (18.7%), with the highest prevalence in Africa (31.5%) and the lowest in North America (10.2%). Key region-specific risk factors included limited access to dermatological care (Africa, Asia), over-the-counter antimicrobial use (Asia, South America), and inadequate infection prevention practices (all regions). Healthcare system factors, such as the availability of rapid diagnostic tests (RDTs) and antimicrobial stewardship programs (ASPs) in community settings, were inversely associated with AMR prevalence. This study highlights significant global disparities in AMR among CA-SSTIs, driven by a complex interplay of patient, healthcare, and systemic factors. Targeted interventions, including expanding access to RDTs, implementing context-specific ASPs, and strengthening public health education, are critical to addressing these disparities and improving CA-SSTI treatment outcomes worldwide.

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Vector-borne diseases (VBDs) represent a major global public health threat, with climate change emerging as a key driver of their expanding geographic range and increased incidence. This study aims to systematically analyze the global vulnerability of populations to climate-sensitive VBDs, quantify the impacts of climate change on the transmission dynamics of major VBDs (malaria, dengue, Zika, and Lyme disease), and evaluate region-specific adaptive strategies. A mixed-methods approach was employed, integrating global climate data (1990–2024), VBD incidence records from 120 countries, socioeconomic vulnerability indices, and semi-structured interviews with 150 public health stakeholders across 6 continents. The findings reveal significant global variations in vulnerability, with low- and middle-income countries (LMICs) in tropical and subtropical regions (e.g., sub-Saharan Africa, Southeast Asia, Latin America) exhibiting the highest vulnerability due to a combination of climatic suitability for vectors, weak healthcare infrastructure, and socioeconomic deprivation. Climate change-induced increases in temperature, precipitation, and humidity have extended the seasonal activity of vectors (e.g., Anopheles mosquitoes for malaria, Aedes mosquitoes for dengue) by 2–3 months in temperate regions and expanded their geographic range by 15–25% in high-latitude areas over the past three decades. The incidence of dengue has increased by 78% in Southeast Asia and 65% in Latin America since 2000, with climate change contributing an estimated 30–40% of this increase. Region-specific adaptive strategies, such as vector control programs, early warning systems (EWSs), and climate-resilient healthcare infrastructure, have shown varying degrees of effectiveness. For example, community-based vector control in Senegal reduced malaria incidence by 42%, while EWS implementation in Thailand decreased dengue-related hospitalizations by 35%. However, these strategies face significant barriers in LMICs, including limited funding, inadequate technical capacity, and weak intersectoral collaboration. This study highlights the urgent need for globally coordinated, context-appropriate adaptive strategies that integrate climate data into public health planning, strengthen healthcare systems in vulnerable regions, and address the socioeconomic determinants of VBD vulnerability. Such efforts are critical to mitigating the growing burden of climate-sensitive VBDs and advancing global health equity.

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Antimicrobial resistance (AMR) has emerged as one of the most pressing global public health crises of the 21st century, threatening to reverse decades of progress in infectious disease control. This study aims to systematically analyze the multifaceted challenges of AMR from a global governance perspective, evaluate the progress made by international, regional, and national governance initiatives, and propose evidence-based future directions to strengthen AMR governance. A mixed-methods approach was adopted, integrating a systematic review of 180 peer-reviewed studies and policy documents (2015–2024), case studies of 15 countries across different income levels and regions, and semi-structured interviews with 120 stakeholders (policymakers, healthcare providers, researchers, and industry representatives). The findings reveal that AMR governance faces four core challenges: (1) Fragmented governance structures with inadequate coordination among international organizations, governments, and non-state actors; (2) Unequal access to quality antimicrobials and diagnostic tools between high-income countries (HICs) and low- and middle-income countries (LMICs); (3) Insufficient investment in AMR surveillance, research and development (R&D) of new antimicrobials, and infection prevention and control (IPC) measures; (4) Lack of effective mechanisms to regulate antimicrobial use in human, animal, and environmental sectors (the “One Health” gap). Despite these challenges, significant progress has been made, including the adoption of the WHO Global Action Plan on AMR, the establishment of regional AMR surveillance networks, and the implementation of national AMR action plans in over 170 countries. However, implementation gaps remain, particularly in LMICs, due to limited resources, weak health systems, and inadequate technical capacity. Case study analysis shows that countries with strong intersectoral collaboration, robust surveillance systems, and targeted investments in IPC have achieved better AMR control outcomes. The study proposes four key future directions for strengthening AMR governance: (1) Establish a centralized global AMR governance body to enhance coordination; (2) Promote equitable access to antimicrobials and diagnostics through innovative financing mechanisms; (3) Increase global investment in AMR R&D and surveillance, with a focus on LMIC needs; (4) Accelerate the adoption and implementation of One Health approaches at all levels. This study emphasizes that addressing AMR requires a coordinated, multi-sectoral, and equity-centered global governance response, and provides actionable insights for policymakers, international organizations, and other stakeholders to advance AMR control efforts.

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