Search Results (792)

Pseudomonas aeruginosa is an important opportunistic pathogen increasingly associated with multidrug resistance (MDR) and therapeutic failure. Data on MDR community-associated P. aeruginosa in southern Morocco remain limited. This study evaluated the contribution of urban diagnostic laboratories to the surveillance of MDR P. aeruginosa in this underrepresented region. A retrospective multicenter study was conducted between January and December 2024 using data collected from urban medical diagnostic laboratories in southern Morocco. Clinical isolates of P. aeruginosa recovered from community-associated patients were identified using standard microbiological methods, and antimicrobial susceptibility testing was performed according to EUCAST guidelines. MDR was defined as non-susceptibility to at least one agent in three or more antimicrobial classes according to the international criteria. Associations between MDR status and demographic variables were assessed using Chi-square and Fisher’s exact tests, with statistical significance set at p < 0.05. Among the 49 P. aeruginosa isolates included, 29 (59.2%, 95% CI: 45.4–72.0%) were classified as MDR. High resistance rates were observed for several β-lactams, whereas most isolates remained susceptible to amikacin and selected β-lactam/β-lactamase inhibitor combinations. No statistically significant association was found between MDR status and demographic variables. These findings highlight the circulation of MDR P. aeruginosa in southern Morocco and suggest that urban diagnostic laboratories may provide valuable complementary data for community-level antimicrobial resistance surveillance. Full article

Interest is growing in the antimicrobial potential of the non-psychoactive cannabinoids, such as cannabidiolic acid (CBDA) and cannabigerolic acid (CBGA), and their metal systems. The present study follows on from previous potentiometric and ESI-MS studies confirming the formation of stable zinc(II) species with cannabinoid acids in an alcohol–water environment under physiological conditions. The antibacterial action of the compounds was assessed against reference Gram-negative strains (Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis) and Gram-positive strains (Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis) using minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) assays. Their cytotoxicity was also evaluated in vitro using mouse fibroblasts. The tested compounds were found to demonstrate pronounced selectivity against Gram-positive bacterial strains compared to Gram-negative bacteria. The antibacterial efficacy of the free ligands was enhanced by the presence of Zn(II) in the solution: the equilibrium mixtures exhibited greater inhibitory activity against E. faecalis and S. epidermidis, with MIC and MBC values being non-cytotoxic toward L929 fibroblasts under the tested in vitro conditions. However, Gram-negative bacteria were only found to be susceptible at elevated concentrations, which also induced cytotoxic effects. Among the free ligands, CBGA exhibited slightly stronger antibacterial activity than CBDA. Full article

Non-aeruginosa Pseudomonas (NAP) species represent a diverse and ubiquitous group of Gram-negative bacteria inhabiting a wide range of environmental niches, from soil and water to plant rhizospheres and clinical settings. While Pseudomonas aeruginosa has historically dominated clinical and research focus, the significance of NAP species, such as Pseudomonas fluorescens, Pseudomonas putida, and Pseudomonas stutzeri, as both opportunistic human pathogens and versatile biotechnological agents is increasingly recognized. Their remarkable genomic plasticity, driven by large accessory genomes and mobile genetic elements, underpins their metabolic versatility and adaptability but also facilitates the acquisition of virulence determinants and antibiotic resistance genes, contributing to their emergence in healthcare settings, particularly among immunocompromised individuals. This review provides a comprehensive analysis of NAP species, focusing on recent advances in their taxonomy facilitated by genomic tools like Whole-Genome Sequencing (WGS) and Multilocus Sequence Typing (MLST), which reveal complex species groups and challenge traditional classifications. We delve into the genomic landscape, exploring pangenome dynamics, horizontal gene transfer (HGT), and the genomic signatures that may differentiate clinical from environmental isolates. The clinical relevance of NAPs is examined, detailing the spectrum of infections, epidemiological trends, risk factors, and insights into virulence mechanisms, including secretion systems (T3SS, T6SS) and pathogenicity islands. Addressing a critical need, this review incorporates detailed sections on the diagnostic challenges posed by NAPs, including common misidentifications and the role of modern techniques like MALDI-TOF MS and WGS, and outlines current and novel therapeutic strategies, considering the growing problem of antimicrobial resistance (AMR) within this group. Furthermore, the biotechnological applications of NAPs in bioremediation and biocatalysis are discussed alongside evolving biosafety considerations, reflecting the shift from strict containment to integrated monitoring approaches for genetically engineered strains. By synthesizing current knowledge and highlighting research gaps, this review underscores the necessity of integrated, One Health approaches to understand and manage the dual nature of non-aeruginosa Pseudomonas species as both environmental inhabitants and clinically relevant pathogens. Full article

Background: Hydrogel membranes are highly effective biomaterials with huge potential for advanced wound management, offering the dual advantage of maintaining a beneficial moist environment while serving as a localized reservoir for antibacterial agents. Zinc oxide nanoparticles (ZnO NPs) are particularly notable in this regard, possessing potent antibacterial capabilities and intrinsic tissue-healing properties. Methods: In this study, we report the successful fabrication of a novel locust bean gum (LBG) hydrogel encapsulated with ZnO NPs, utilizing AlCl₃ as a cross-linking agent. The synthesized nanocomposite hydrogels were structurally and chemically characterized using Scanning Electron Microscopy (SEM) and Fourier-Transform Infrared Spectroscopy (FTIR) followed by in vivo studies using experimental animals by creating wound model. Results: Physicochemical evaluations revealed a concentration and pH-dependent swelling profile, achieving a maximum swelling capacity of 97% at pH 9. In vitro kinetic studies depicted a highly desirable initial burst release of the active therapeutic, subsequently followed by a continuous, sustained release phase that was strictly governed by non-Fickian diffusion mechanics. Furthermore, the optimized formulations achieved excellent entrapment efficiencies (>95%) and substantial free-radical scavenging antioxidant potential (>86%). Biological assessments confirmed the safety and efficacy of the nanocomposites. The formulations exhibited zero cellular toxicity against fibroblast cell lines and demonstrated complete biocompatibility during tissue histopathological evaluations. Significant antimicrobial activity was also observed, as demonstrated by reduction in the Minimum Inhibitory Concentration (MIC) against critical pathogens, including S. aureus, E. coli, P. aeruginosa, and resistant MRSA strains. Crucially, in vivo studies using experimental animal models demonstrated accelerated tissue remodeling, achieving complete wound healing by day 11 and vastly outperforming the control groups. Finally, in silico molecular docking simulations corroborated these empirical findings, revealing strong and favorable binding interactions of the nanocomposite with key target proteins to elucidate its underlying antibacterial mechanisms. Conclusions: Collectively, these results establish the ZnO-loaded LBG hydrogel as a safe, multifunctional, and highly efficient topical drug delivery platform for cutaneous wound healing. Full article

Background: The global emergence of antibiotic resistance highlights the urgent need for novel therapeutic strategies, including adjuvants and potentiating compounds, against multidrug-resistant bacteria. Pseudomonas aeruginosa is classified by the World Health Organization (WHO) as a critical priority pathogen due to its high resistance potential and its ability to cause severe nosocomial infections. Beauvericin (BEA), a frequently detected mycotoxin, has been reported to exhibit various bioactive properties, including potential antibacterial and potentiating effects. Methods: The interaction between BEA and a last-resort antibiotic, colistin (COL), was evaluated in seven multidrug-resistant P. aeruginosa isolates using a microplate-based growth assay after preliminary MIC tests. Results: BEA at non-inhibitory concentrations (2.5–10 µg/mL) significantly enhanced the antibacterial activity of COL (1 and 2 µg/mL) in six out of seven isolates, resulting in a marked reduction in residual bacterial growth. Conclusions: BEA exhibited no measurable antibacterial activity at the concentrations used in the combination experiments but acted as a strain-dependent potentiator of colistin activity against multidrug-resistant P. aeruginosa. The observed enhancement of colistin-mediated growth inhibition supports the potential of BEA as an antibiotic adjuvant at clinically relevant colistin concentrations and provides a basis for further mechanistic investigation. Full article

Background: Iodine-based antimicrobial systems remain highly attractive due to their broad-spectrum activity; however, the clinical application of free iodine is limited by its instability and cytotoxicity. This study aimed to develop polyethylene glycol (PEG)-based hydrophilic ointment formulations containing a dextrin/polyvinyl alcohol/iodine complex (D/PVA/I) and to evaluate their physicochemical properties, antimicrobial activity, and cytotoxicity. Methods: Hydrophilic ointment formulations containing 2.5%, 5.0%, and 10.0% D/PVA/I were prepared using a PEG-based matrix composed of PEG 4000, PEG 400, and glycerol. Physicochemical characterization included organoleptic evaluation, pH measurement, rheological analysis, and UV–visible (Ultraviolet–visible) spectroscopy. Antimicrobial activity was assessed using agar diffusion and minimum bactericidal concentration (MBC) assays against Staphylococcus aureus, Escherichia coli, Enterococcus hirae, and Pseudomonas aeruginosa. Cytotoxicity was evaluated in Madin–Darby Canine Kidney (MDCK) cells using the MTT assay. Results: All formulations exhibited homogeneous semisolid structure and physiologically acceptable pH values (4.94–5.45). Rheological analysis demonstrated non-Newtonian pseudoplastic (shear-thinning) behavior. The flow behavior index (n) ranged from 0.03 to 0.33 according to the Ostwald–de Waele model, confirming shear-thinning characteristics, while viscosity increased with increasing D/PVA/I concentration. UV–visible spectroscopy confirmed the presence of triiodide ions (I_3⁻), characterized by absorption maxima at approximately 287 and 350 nm, indicating preservation of active iodine species within the PEG matrix, while placebo (blank) formulation analysis confirmed the absence of corresponding absorption bands, demonstrating that the PEG-based matrix does not contribute to the characteristic spectral features. The formulations demonstrated broad-spectrum antimicrobial activity, with MBC values ranging from 0.01 to 0.02 µg/mL. Cytotoxicity studies revealed moderate toxicity of the D/PVA/I complex (CC₅₀ = 0.82%) (50% cytotoxic concentration (CC₅₀) and significantly lower toxicity of the PEG-based ointment base (CC₅₀ = 18.38%). Conclusions: The developed PEG-based hydrophilic ointment formulations containing the D/PVA/I complex demonstrated favorable physicochemical characteristics, stability of iodine species, pronounced antimicrobial activity, and acceptable cytotoxicity profiles. These findings highlight the potential for the developed systems to be promising topical antimicrobial formulations. Full article

This study presents a transformative “one-pot” biorefinery approach for the simultaneous production of hyaluronic acid (HA) and polyhydroxybutyrate (PHB) using an engineered, non-pathogenic Halomonas bluephagenesis TD01 chassis. By leveraging the principles of Next-Generation Industrial Biotechnology (NGIB), a one-step fermentation process was developed in nutrient-rich 40-LBG-Y medium, achieving a balanced metabolic flux that yielded 1.99 g/L and high-molecular-weight (HMw) HA (9.6 × 10⁶ Da) as the highest HA-Mw reported by heterogeneous bacteria, alongside intracellular PHB (0.68 to 1.6 g/L). A bioactive HA-PHB nanoparticle scaffold was fabricated, exhibiting a highly porous, interconnected 3D sponge-like architecture with a significant particle size shift from 12 nm to 450 nm, confirming successful polymer complexation. Antimicrobial evaluations revealed that the scaffold exhibited preliminary antimicrobial potential against representative Gram-positive and Gram-negative strains against Staphylococcus aureus, Klebsiella variicola, and Candida albicans. Notably, while Pseudomonas aeruginosa metabolically exploited purified HA, the integrated scaffold reversed this effect, providing preliminary antimicrobial potential by sterically hindering bacterial hyaluronidases. Furthermore, Halomonas-derived HA consistently outperformed Moringa oil and complex emulsions in preliminary tests against a wide range of pathogenic microbes. These results demonstrate that this dual-product platform provides a sustainable, cost-effective source of high-performance functional materials for advanced antimicrobial coatings and clinical wound management. Full article

Non-cystic fibrosis bronchiectasis (NCFB) is a heterogeneous chronic airway disease characterized by irreversible bronchial dilatation, impaired mucociliary clearance, and recurrent infection. Historically, research and clinical practice have focused mainly on bacteria, particularly Pseudomonas aeruginosa, as major drivers of exacerbations and disease progression, whereas the contribution of fungi has received far less attention. Over the last decade, evidence from mycobiome studies, large registries, and prospective cohorts has increasingly identified Aspergillus spp. as clinically relevant contributors in a substantial subset of patients with bronchiectasis. Data from the European Bronchiectasis Registry (EMBARC) indicate that approximately one quarter of patients exhibit Aspergillus-related immunological signals, including allergic bronchopulmonary aspergillosis (ABPA), Aspergillus sensitization, and elevated Aspergillus-specific IgG, and that these phenotypes are associated with more severe disease and worse clinical outcomes. Mechanistic studies further suggest that Aspergillus-related disease in bronchiectasis is underpinned by distinct molecular and immunological programs involving epithelial dysfunction, impaired mucociliary clearance, innate fungal sensing, inflammasome-related signaling, and divergent type-2 versus non-type-2 inflammatory responses. In parallel, mycobiome and multi-biome studies indicate that Aspergillus should be interpreted within a broader airway interactome shaped by cross-kingdom relationships with bacterial pathogens and by host immune tone. In this review, we synthesize current evidence on the epidemiology, molecular pathobiology, inflammatory endotypes, biomarker profiles, clinical–radiologic spectrum, and therapeutic implications of Aspergillus in bronchiectasis. Current evidence suggests that Aspergillus-related findings in bronchiectasis should be interpreted within a structured clinical, radiological, microbiological, and immunological framework rather than considered solely as isolated culture results. However, most data remain observational or extrapolated from related airway diseases, and bronchiectasis-specific interventional evidence is limited. A cautious biomarker-informed approach may help standardize phenotyping, identify patients requiring closer follow-up, and define priorities for future prospective trials. Full article

Massilia varians has potential as a probiotic to inhibit bacterial pathogens in aquaculture, but very limited information is available regarding its use in Chinese mitten crab Eriocheir sinensis for enhancing host immunity, antioxidant ability and intestinal microbiota homeostasis. In this study, a 40-day feeding trial was conducted to evaluate the protective effects of dietary supplementation with M. varians P2-4 on nonspecific immune response, antioxidant status, intestinal microbiota and resistance against Pseudomonas aeruginosa infection in E. sinensis. Results demonstrated that dietary supplementation with M. varians P2-4 at 6.0 × 10⁶ to 6.0 × 10⁸ CFU/g diet significantly boosted nonspecific immunity and improved antioxidant capability of E. sinensis, mainly as evidenced by markedly increased activities of plasma lysozyme, plasma superoxide dismutase, hepatopancreatic superoxide dismutase and catalase. Furthermore, crabs fed M. varians P2-4-supplemented diets exhibited markedly improvements in intestinal microbiota composition and diversity, and showed substantially enhanced survival following P. aeruginosa challenge, with 7-day relative percentage survival ranging from 76.9% to 100.0%. To the best of our knowledge, this is the first study to reveal that M. varians P2-4 supplementation functions as a new biocontrol strategy in E. sinensis by effectively improving the non-specific immunity, antioxidant status and intestinal microbiota to mitigate P. aeruginosa infection. Full article

Background/Objectives: Catheter-associated urinary tract infections (CAUTIs) are one of the most common healthcare-related morbidities. Also, severe clinical outcomes derived from CAUTIs demand an urgent need for the development of novel antimicrobial catheter materials. Since CAUTIs are primarily driven by a wide range of microorganisms causing biofilm formation on the surfaces of catheters, evaluating the effectiveness of innovative antimicrobial materials against a broad spectrum of known uropathogens is warranted. We aim (1) to demonstrate the ability of incorporated organo-selenium versus that of an FDA-cleared antimicrobial catheter and (2) to show that the results of the study are consistent against the most common microorganisms causing urinary tract infections in humans. Methods: Based on encouraging preliminary studies, three percent of organo-selenium (weight-based), as a novel antimicrobial catheter material, was incorporated into thermoplastic polyurethane (TPU). This was compared in vitro with plain polyurethane catheters and the SILQ ClearTract catheter with a zwitterionic coating (FDA-cleared for its antimicrobial properties in December 2022). The antimicrobial activity was studied against Candida albicans, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, MRSA, and Staphylococcus epidermidis by assessment of colony-forming unit counts along with visual confirmation using Scanning Electron Microscopy (SEM). Results: Plain polyurethane catheters (control group) showed 7- to 8-log of in vitro growth for all tested microbes, whereas the antimicrobial zwitterionic SILQ ClearTract catheters still showed 6- to 7-log of microbial growth. In contrast, organo-selenium-incorporated catheters demonstrated no detectable in vitro growth for all tested microbes (C. albicans, E. coli, K. pneumoniae, P. mirabilis, P. aeruginosa, S. aureus, MRSA, and S. epidermidis). SEM analysis also validated the findings. Conclusions: Potentially non-leaching organo-selenium, as a novel urinary catheter material, significantly inhibited microbial attachment, growth, and biofilm formation across a wide spectrum of common uropathogenic organisms compared to a zwitterionic catheter, providing a strong foundation for further detailed in vivo and clinical studies. Full article

Background and Objectives: Multidrug-resistant (MDR) uropathogens are reshaping the empirical management of acute pyelonephritis, particularly in Eastern European centers. We aimed to describe MDR patterns, identify admission-level predictors, including renal impairment/renal-failure status at presentation and major healthcare exposure variables, and derive a bedside risk score (PYELO-MDR-Risk) for adult pyelonephritis at a Romanian tertiary hospital. Methods: We retrospectively analyzed 129 consecutive culture-confirmed acute pyelonephritis admissions at “Victor Babeș” University Hospital, Timișoara (March 2022–March 2025). MDR was defined as non-susceptibility to ≥1 agent in ≥3 antimicrobial categories. We compared MDR and non-MDR cases on demographics, microbiology, time-to-effective therapy (TTE), and outcomes; multivariable logistic regression identified independent predictors and was the basis for a points-based score with bootstrap-based internal validation (1000 resamples). Results: Fifty-four patients (41.9%) had MDR pyelonephritis. Escherichia coli remained the dominant uropathogen (55.8%) but was less prevalent in the MDR group (40.7% vs. 66.7%; p = 0.003), whereas Klebsiella pneumoniae and Pseudomonas aeruginosa were enriched. Independent predictors of MDR were antibiotic exposure ≤90 days (aOR 5.7, 95% CI 2.4–13.6), recurrent UTI (aOR 3.4, 1.4–8.2), recent hospitalization (aOR 3.1, 1.2–8.0), and renal impairment/renal-failure status at admission (aOR 2.4, 1.0–6.2). Immunosuppression, prior urinary tract instrumentation, and nephrolithiasis/urolithiasis were evaluated as candidate predictors but did not independently improve the final point score after adjustment. MDR was associated with delayed effective therapy (28.4 vs. 9.7 h; p < 0.001), longer hospitalization (13.7 vs. 8.9 days; p < 0.001), and higher 30-day readmission (20.4% vs. 8.0%; p = 0.038). The PYELO-MDR-Risk score (range 0–12) achieved an optimism-corrected AUC of 0.84 with adequate calibration (Hosmer–Lemeshow p = 0.624). Conclusions: MDR drives a substantial fraction of pyelonephritis admissions in Western Romania and tracks closely with prior antibiotic and healthcare exposure. The PYELO-MDR-Risk score offers a transparent bedside tool for empirical-therapy decisions in the local setting, pending national and international external validation. Full article

Inadequate surface sanitization represents a significant risk to sterility assurance and regulatory compliance. Therefore, an effective cleaning and disinfection program is a critical component of contamination control strategies in pharmaceutical facilities manufacturing sterile medicinal products. This study aimed to standardize a carrier-based methodology for evaluating the efficacy of disinfectants against in-house environmental isolates recovered from a pharmaceutical industry facility. Nine representative strains were selected from five different groups—Gram-positive non-spore-forming bacteria (Micrococcus luteus and Kocuria spp.), Gram-positive spore-forming bacteria (two Bacillus spp. strains), Gram-negative bacteria (Pseudomonas aeruginosa and Acinetobacter haemolyticus), yeasts (Candida parapsilosis and Rhodotorula mucilaginosa), and filamentous fungus (Penicillium spp.)—based on historical environmental monitoring data (2012–2022), and were characterized using matrix-assisted laser desorption/ionization-time-of-flight/mass spectrometry (MALDI-TOF MS) and molecular sequencing (16S rRNA or D2 LSU rDNA). Disinfectant efficacy was assessed on stainless-steel and low-density polyethylene surfaces using NF T 72-281:2014 with adaptations, testing alcohol 70%, sodium hypochlorite 0.5%, quaternary ammonium 0.05%, peracetic acid 0.5%, and accelerated hydrogen peroxide wipes. All agents demonstrated ≥5 log₁₀ reductions against vegetative bacteria and fungi on both surfaces. However, variable sporicidal performance was observed, particularly for one Bacillus cereus group strain (B1342/15), which showed limited viability reduction on stainless steel. These findings highlight inter-strain variability and the greater tolerance of surface-associated spores. The study reinforces the importance of carrier-based testing using in-house isolates to ensure realistic validation of disinfectants and to strengthen microbiological risk management within pharmaceutical contamination control strategies. Full article

The renin–angiotensin system (RAS) regulates inflammation, tissue homeostasis, and barrier integrity in lung and colon epithelial cells. Beyond classical pathways, non-canonical components including angiotensin-converting enzyme 2 (ACE2), epidermal growth factor receptor (EGFR), insulin-like growth factor 2 receptor (IGF2R) and aminopeptidase N (ANPEP) are implicated in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and bacterial sepsis due to their roles in tissue repair and signaling. Despite their similar inflammatory and coagulopathic features, their impact on RAS-associated non-immune gene expression in epithelial tissues remains unclear. This study investigates the regulation of these targets in lung (BEAS-2B) and colon (CRL-1831) cells following exposure to recombinant SARS-CoV-2 spike protein N-terminal domain fragment (S1-NTD) and Pseudomonas aeruginosa-derived lipopolysaccharide (LPS). Cells were treated with 100 ng/mL of S1-NTD or LPS for 12–72 h. Viability was assessed via XTT assays, and molecular changes were analyzed through qRT-PCR and Western blotting. Both stimuli induced a time and dose-dependent decrease in metabolic activity. ACE2 was significantly downregulated in lung cells, while transient upregulation occurred in colon cells at 24 h. EGFR expression increased in colon cells following LPS exposure but decreased in lung cells after S1-NTD treatment. Both IGF2R and ANPEP were upregulated by S1-NTD in lung cells at 72 h, whereas colon cells showed earlier upregulation at 24–48 h. Our findings reveal that viral and bacterial stimuli elicit distinct, tissue-specific regulatory patterns in RAS-associated pathways. These alterations may contribute to epithelial barrier dysfunction and inflammation, highlighting these proteins as potential targets for managing secondary bacterial infections and inflammatory lung–gut complications in COVID-19. Full article

Antimicrobial resistance (AMR) constitutes a critical and escalating global public health challenge, severely limiting the potential of existing antimicrobial drugs and escalating infection-associated morbidity and mortality rates. This analysis focuses on the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), which are prioritized by the World Health Organization (WHO) and represent a significant cause of nosocomial infections due to their extensive drug resistance. We provide an in-depth review of the global prevalence and specific antibiotic-resistant mechanisms of these pathogens. Due to the decline in the traditional antibiotic development pipeline, accelerated development of alternative therapeutic strategies is essential. The review comprehensively discusses innovative non-traditional therapies currently being explored to bypass traditional antibiotic limitations, such as phage therapy, antimicrobial peptides (AMPs), anti-virulence therapies, fecal microbiota transplantation (FMT), and targeted CRISPR-based approaches. Addressing the ESKAPE challenge requires a concerted, multi-sectoral strategy guided by the One Health principle, focusing on enhancing public awareness, improving surveillance and research, optimizing judicious antibiotic use, and cultivating sustainable investment in novel interventions. Full article

Background: Antimicrobial resistance (AMR) is a growing global health threat, disproportionately affecting low- and middle-income countries such as Sudan. Conflict-related health system disruption has further intensified inappropriate antibiotic use and weakened stewardship capacity. Objective: This narrative review synthesizes contemporary evidence on antibiotic prescribing practices in Sudan, with emphasis on ambulatory care, and examines their implications for AMR control in the context of ongoing conflict. Methods: A non-systematic, structured narrative review was conducted successfully. PubMed, Google Scholar, WHO/EMRO databases, and Sudan’s National Action Plan (NAP) materials were examined for literature published between January 2010 and December 2025. Peer-reviewed research, government guidelines, surveillance reports, and gray literature were among the eligible sources. A total of 78 studies were included after titles, abstracts, and full texts were screened. Two reviewers independently confirmed the data extraction, and the synthesis aligned with SANRA guidelines. Results: Antibiotic prescribing in Sudan is frequently inappropriate, particularly in ambulatory and community settings, where empirical treatment, polypharmacy, and extensive use of Watch antibiotics are common. Alignment with WHO AWaRe recommendations remains suboptimal. Recent clinical and molecular evidence demonstrates increasing multidrug resistance among Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus, including ESBL production and emerging carbapenemase genes (e.g., NDM 1, IMP 1). Conflict-related disruptions—such as reduced laboratory capacity, supply chain breakdown, and unregulated community dispensing—have further accelerated AMR. Pilot stewardship interventions show promise but remain limited in scale. Conclusions: Inappropriate antibiotic use in Sudan is driven largely by ambulatory and community practices and has been exacerbated by conflict. Strengthening stewardship beyond hospitals, enforcing prescription-only regulations, operationalizing the AWaRe framework, and aligning empirical therapy with local resistance patterns are critical for mitigating AMR in Sudan and similar conflict-affected settings. Full article