Global genomic surveillance uncovers emergence and spatiotemporal patterns of World Health Organization priority antibiotic resistance in invasive Salmonella.

Antimicrobial resistance (AMR) in invasive Salmonella infections remains a global public health concern, and enhanced high-quality genomic surveillance is essential to inform guidelines and policies. Here, we aimed to describe clinically key antibiotic resistance trends in invasive Salmonella infections using 7691 isolates derived from national surveillance and publicly available datasets between 1954 and 2024. 29 (37.7%) of 77 countries identified at least one isolate with resistance or decreased susceptibility to ciprofloxacin, 25 (32.5%) and 29 (37.7%) countries resistance or decreased susceptibility to ceftriaxone and cefixime, 8 (10.4%) countries resistance to azithromycin, 15 (19.5%) countries resistance to fosfomycin, 10 (13.0%) countries resistance to colistin. Overall, 7.39% of 7691 isolates were resistant or decreased susceptibility to ciprofloxacin, 7.91% reported resistance or decreased susceptibility to 3GCs, 4.23% reported resistance to fosfomycin, and 0.79% reported resistance to azithromycin. Globally, azithromycin resistance is increasing, as is resistance or decreased susceptibility to ciprofloxacin, 3GCs, and 4GCs. However, surveillance levels remain inadequate in African and South American regions. We generated a global map of clinically key antibiotic resistance genes in invasive Salmonella infections worldwide. This retrospective, global, longitudinal genomic epidemiology study on invasive Salmonella provides evidence-based data for clinical guidelines, genomic surveillance, AMR control, and public health policies.