| Summary: | <p>Antimicrobial resistance of Gram-negative bacteria is increasingly reported worldwide, rendering multiple antibiotics ineffective. <em>Shigella</em> is the second leading cause of diarrheal mortality, with an estimated 264 million episodes of shigellosis and 220,000 deaths annually. <em>Escherichia coli</em> and <em>Klebsiella pneumoniae</em> are the most common causes of community- and hospital-acquired Gram-negative bloodstream infections. Identifying the spatial and temporal trends in the distribution of drug-resistant Gram-negative bacteria are important to identify hotspots of disease, close gaps in knowledge, and inform policy regarding the use of antibiotics.</p>
<p>A systematic review compiled a global dataset of the proportion of <em>Shigella</em> isolates with nalidixic acid resistance, linked to time and geographic location. Data were extracted from the published literature, from 1990 to 2018. A meta-analysis of nalidixic acid resistance was calculated and presented by region and 5-year time periods. A second systematic review was initiated to determine the proportion of antimicrobial resistance in <em>Escherichia coli</em> isolates. Data were also extracted from the published literature, from 1990 to 2018. A metaanalysis of seven antimicrobials was calculated and presented by antimicrobial, region, and 5-year time periods.</p>
<p>The proportion of antimicrobial resistant isolates globally were predicted using a geospatial modeling framework on a national level. Maps were produced to identify trends in resistance over a 30-year period in each country worldwide.</p>
<p>This thesis documents high rates of fluoroquinolone resistance in <em>Shigella</em> and <em>Escherichia coli</em> and carbapenems resistance in <em>Escherichia coli</em> and 3rd generation cephalosporin resistance in <em>Escherichia coli</em>. The prevalence of AMR in <em>Shigella</em> and <em>Escherichia coli</em> is provided in detail, and global trends across time are examined. These estimates can be used as a baseline to inform intervention and the development of policies to combat AMR.</p>
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