Antimicrobial resistant Salmonella enterica serovar Concord (S. Concord) is known to cause severe gastrointestinal and bloodstream infections in patients from Ethiopia and Ethiopian adoptees, and occasional records exist of S. Concord linked to other countries. The evolution and geographical distribution of S. Concord remained unclear. Here, we provide a genomic overview of the population structure and antimicrobial resistance (AMR) of S. Concord by analysing genomes from 284 historical and contemporary isolates obtained between 1944 and 2022 across the globe. We demonstrate that S. Concord is a polyphyletic serovar distributed among three Salmonella super-lineages. Super-lineage A is composed of eight S. Concord lineages, of which four are associated with multiple countries and low levels of AMR. Other lineages are restricted to Ethiopia and horizontally acquired resistance to most antimicrobials used for treating invasive Salmonella infections in low- and middle-income countries. By reconstructing complete genomes for 10 representative strains, we demonstrate the presence of AMR markers integrated in structurally diverse IncHI2 and IncA/C2 plasmids, and/or the chromosome. Molecular surveillance of pathogens such as S. Concord supports the understanding of AMR and the multi-sector response to the global AMR threat. This study provides a comprehensive baseline data set essential for future molecular surveillance.

Adrem Data Lab Department of Computer Science University of Antwerp Antwerp Belgium

Antimicrobial Resistance and Microbial Ecology Group School of Medicine University of Galway Galway Ireland

Austrian Agency for Health and Food Safety Institute for Medical Microbiology and Hygiene 8010 Graz Austria

Cambridge Institute of Therapeutic Immunology and Infectious Disease Department of Medicine University of Cambridge Cambridge CB2 0SP United Kingdom

Clinical Reference Laboratory Department of Clinical Sciences Institute of Tropical Medicine Antwerp Belgium

Department of Bacteriology Host Pathogen Interaction and Diagnostics Wageningen Bioveterinary Research Lelystad The Netherlands

Department of Bacteriology Mycology and Parasitology Statens Serum Institut 5 Artillerivej DK 2300 Copenhagen S Denmark

Department of Biomedical Sciences Institute of Tropical Medicine Antwerp Belgium

Department of Health Policy and Management School of Public Health Faculty of Health Sciences Ben Gurion University of the Negev Beer Sheva Israel

Department of Medical Laboratory Sciences Faculty of Health Sciences Jimma University Jimma Ethiopia

Department of Microbiology Immunology and Transplantation KU Leuven Leuven Belgium

Division of Foodborne Waterborne and Environmental Diseases Centers for Disease Control and Prevention Atlanta GA USA

Division of Human Bacterial Diseases Sciensano Brussels Belgium

Gastrointestinal Bacterial Reference Unit United Kingdom Health Security Agency Colindale London UK

Institut Pasteur Université Paris Cité Unité des bactéries pathogènes entériques F 75015 Paris France

Institute of Infection Veterinary and Ecological Sciences University of Liverpool Liverpool UK

Laboratory of Medical Microbiology Vaccine and Infectious Disease Institute University of Antwerp Antwerp Belgium

London School of Hygiene and Tropical Medicine Bloomsbury London UK

MRC Centre for Molecular Bacteriology and Infection Imperial College London London UK

National Reference Laboratory for salmonella State Veterinary Institute Prague Prague Czech Republic

Norwich Medical School University of East Anglia Norwich UK

Quadram Institute Bioscience Norwich Research Park Norwich UK

Technical University of Denmark National Food Institute Research Group of Global Capacity Building Kgs Lyngby Denmark

Unit of Tropical Bacteriology Department of Clinical Sciences Institute of Tropical Medicine Antwerp Belgium

Wellcome Trust Sanger Institute Genome Campus Hinxton Cambridge United Kingdom

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