{
  "abstract": "The long-term burden of antimicrobial resistance (AMR) in hyper-urbanised settings, shaped by complex, multi-sectoral transmission dynamics across human, animal, and environmental reservoirs, remains poorly understood. Using Singapore as a case study, we applied a dynamic One Health modelling framework to explore how ESBL-producing Enterobacterales infections and deaths may evolve over the next decade and identify critical control pathways. We developed a deterministic, compartmental One Health transmission model, the first to integrate hospital, community, companion animal, and environmental reservoirs, calibrated to ten years of national hospital surveillance data (2012−2021) using Markov Chain Monte Carlo Bayesian methods. We projected the baseline disease burden over a 10-year reporting horizon and compared it with counterfactual scenarios while employing global and local sensitivity analyses to identify influential parameters. Over this period, the model projected a total burden of 208,179 clinical ESBL-producing Enterobacterales infections (95% uncertainty interval [UI] 121,669–307,053) and 5567 (95% UI 3660–7806) deaths, with 3491 deaths specifically attributable to ESBL-producing Enterobacterales. Community decolonization strongly influenced infection burdens in both community and hospital settings; a 100% reduction in this process was projected to add nearly 1.8 million additional infections and more than 45,000 resistant-infection deaths across hospital and community settings in Singapore over 10 years. Our dynamic One Health model quantifies these inter-sectoral transmission pathways and identifies clear intervention priorities. While preventing progression from colonisation to infection is vital for reducing hospital-specific mortality, comprehensive system-wide control may benefit from targeting the community reservoir. Ultimately, the modelling framework developed here provides a robust, transferable tool for other global cities to design and evaluate integrated One Health AMR control strategies to mitigate urgent public health threats and associated socio-economic consequences for urban populations and global healthcare systems.",
  "abstract_shown": true,
  "affiliations": [
    "Programme in Health Services & Population Health Research, Duke-NUS Medical School, Singapore; SingHealth Duke-NUS Global Health Institute, Duke-NUS Medical School, Singapore",
    "Programme in Health Services & Population Health Research, Duke-NUS Medical School, Singapore",
    "Saw Swee Hock School of Public Health, National University of Singapore, Singapore",
    "Programme in Health Services & Population Health Research, Duke-NUS Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore",
    "Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand",
    "Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Corresponding author at: Saw Swee Hock School of Public Health, National University of Singapore, Singapore."
  ],
  "article_type": "research article",
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  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yewei Xie"
    },
    {
      "affs": [
        1
      ],
      "name": "Nicholas Graves"
    },
    {
      "affs": [
        2
      ],
      "name": "Zhi Zhen Lim"
    },
    {
      "affs": [
        3
      ],
      "name": "Alec Morton"
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    {
      "affs": [
        2
      ],
      "name": "Isabelle Maya Srivastava"
    },
    {
      "affs": [
        4
      ],
      "name": "Yot Teerawattananon"
    },
    {
      "affs": [
        2
      ],
      "name": "Hwee Lin Wee"
    },
    {
      "affs": [
        5
      ],
      "name": "Yin Mo"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1qhf5z70ds4hw.bib",
  "cited_by": 0,
  "doi": "10.1016/j.onehlt.2026.101631",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2352771426003150",
  "id": "1qhf5z70ds4hw",
  "issns": [
    "2352-7714"
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  "landing_url": "https://doi.org/10.1016/j.onehlt.2026.101631",
  "language": "en",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
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  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
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      "heading",
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      "lcc",
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      "openalex",
      "1313|Antibiotic Resistance in Bacteria"
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  "openalex": "W7223212313",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13722557/pdf/?tool=EBI",
  "pmcid": "PMC13722557",
  "pmid": "42966920",
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/1qhf5z70ds4hw.ris",
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  "subjects": [
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  "title": "Modelling the transmission and burden of ESBL-producing Enterobacterales from a One Health perspective in Singapore",
  "title_text": "Modelling the transmission and burden of ESBL-producing Enterobacterales from a One Health perspective in Singapore",
  "type": "peer-reviewed",
  "updated_at": "2026-11-04T12:21:21Z",
  "url": "https://research.draconitic.com/paper/1qhf5z70ds4hw",
  "venue": "One Health",
  "versions": []
}