Lastly, this is a descriptive piece and we do not make any causal claims but we do try to discuss potential explanations for the observed trends in the paper.

There are several limitations. As a VA study, the patient population differs from the general population in demographics, comorbidities, healthcare-use patterns. BUT we used data from 138 hospitals w/ varying complexity levels, different geographical regions in the US + over 15 y

Ongoing infection control measures, stewardship interventions + surveillance of AMR remain essential. Our study provides a comprehensive view of the antimicrobial landscape in the USA. However, it's also important to monitor and understand local epidemiological patterns.

So, some resistance trends are improving, but others, such as the rise in ESBL-producing Enterobacterales and hospital-associated infections during the COVID-19 pandemic, are concerning. This warrants caution in prescribing antibiotics, particularly 3rd-gen CPH and carbapenems.

We found significant reductions in MRSA, VRE, and fluoroquinolone resistance across **multiple** pathogens, alongside a drastic decline in fluoroquinolone prescribing suggesting the effectiveness of infection control and antimicrobial stewardship efforts.

We hope that the adoption of both measures will become the new standard in reporting, ultimately aiding decision-making in healthcare settings and improving public health strategies.

We highlight the importance of coupling data on resistance proportions (% of resistant isolates) with phenotypic incidence (no. of isolates with resistant, susceptible, or missing test results per population per unit time) to accurately assess and interpret AMR burden and trends.

Free access to the paper until Oct 5 here: authors.elsevier.com/a/1jbJ8_XVyh...