Overview: A Growing Threat in Hospitals Worldwide
Hospitals across the globe are facing an alarming increase in infections that resist standard antibiotic treatments. The World Health Organization (WHO) Global Antibiotic Resistance Surveillance report draws on data from more than 23 million bacterial infections across 104 countries, revealing that one in six laboratory-confirmed infections in 2023 were resistant to antibiotics. With more than 40% of antibiotics losing potency against common infections in the period from 2018 to 2023, health systems are increasingly confronting treatment failures in bloodstream infections, gut infections, urinary tract infections, and some sexually transmitted infections. Experts warn that deaths driven by drug resistance will rise sharply in the coming years if actions aren’t taken.
What the Data Show
The WHO report highlights significant regional disparities. In 2023, one in three bacterial infections in south-east Asia and the eastern Mediterranean were resistant to antibiotics, while one in five in Africa showed resistance. These figures are especially troubling given that many low- and middle-income countries struggle with weaker healthcare systems and infection prevention controls. The data set, though powerful, may be subject to reporting biases—some countries report mainly from specialist hospitals that treat the most severe cases—but it still points to a global pattern of rising resistance.
Key Bacteria and Drugs Under Threat
A central concern is resistance among gram-negative bacteria, which are shielded by an outer membrane and include Escherichia coli and Klebsiella pneumoniae. These pathogens are linked to severe infections that can progress to sepsis and organ failure. Alarmingly, 40% of E. coli and over 55% of K. pneumoniae isolates were resistant to third-generation cephalosporins, a class often used as a frontline therapy. In several regions, resistance to second-line agents—carbapenems and fluoroquinolones—also rose among challenging bacteria like Acinetobacter, K. pneumoniae, and Salmonella. The diminishing effectiveness of these critical antibiotics is narrowing the set of viable treatment options for the sickest patients.
Implications for Mortality and Healthcare Systems
In 2021, drug resistance contributed to about 4.71 million deaths linked to bacterial infections, with 1.14 million deaths directly attributed to resistance. The new findings suggest the toll could climb further, particularly where infection prevention, diagnostics, and access to effective medicines are limited. Dr. Yvan Hutin of WHO emphasizes that rising resistance “puts lives at risk” and limits the ability of clinicians to manage severe infections. The report has amplified calls for strong surveillance systems, rapid diagnostics, and access to effective, narrow-spectrum antibiotics to minimize collateral damage to the microbiome and slow resistance development.
Responses: What Needs to Happen Now
Experts stress a dual approach: accelerate the development of new antibiotics that address the most dangerous resistant bacteria and ensure their appropriate use. Manica Balasegaram of the Global Antibiotic Research and Development Partnership argues that simply creating new drugs is insufficient if they do not reach patients who need them or if they are not developed in the first place. Sanjib Bhakta from University College London underscores the need for tailored global action, including enhanced surveillance, better diagnostics, equitable access to targeted therapies, infection prevention measures, clean water, sanitation, vaccination, and the strengthening of health systems. He also calls for renewed investment in interdisciplinary research to discover novel therapeutic strategies against drug-resistant bacteria.
Looking Ahead
The WHO report signals a critical tipping point in antimicrobial resistance (AMR). Without swift, coordinated action—spanning policy, clinical practice, and scientific innovation—the rate of resistant infections and related deaths is likely to accelerate. Countries with robust healthcare infrastructure and investments in infection control will be better positioned, but global solidarity is essential to prevent a widening gap between high-income settings and vulnerable regions. As the authors and experts note, reducing unnecessary antibiotic use, improving hygiene and vaccination, and prioritizing diagnostics are foundational steps toward preserving antibiotic effectiveness for future generations.
