Overview: A Growing Hospital Threat
Hospitals around the world are reporting an alarming uptick in infections that no longer respond to standard antibiotic treatments. The World Health Organization’s Global Antibiotic Resistance Surveillance data show that in 2023, one in six laboratory-confirmed bacterial infections were resistant to antibiotics. Across 104 countries, more than 23 million infections were studied, revealing an ongoing erosion of the medicines that once reliably saved lives.
Key Findings: Where Resistance Is Hitting Hardest
Between 2018 and 2023, more than 40% of antibiotics were losing potency against common infections such as blood, gut, urinary tract, and some sexually transmitted infections. The problem is most acute in low- and middle-income countries and in health systems with weaker infection prevention and control, diagnostics, and access to effective medicines.
The WHO estimates that in 2023, about one in three bacterial infections in south-east Asia and the eastern Mediterranean were resistant to antibiotics, with Africa seeing one in five resistant infections. These disparities reflect differences in surveillance, healthcare infrastructure, and the availability of essential medicines.
A Closer Look at the Bacteria
The report highlights a growing threat from gram-negative bacteria, such as Escherichia coli and Klebsiella pneumoniae, which possess an outer shell that helps them resist many drugs. Resistance to first-line therapies leaves clinicians few options and increases the risk of sepsis, organ failure, and death.
Drugs Losing Ground: Critical Antibiotics Under Pressure
Resistance to second-choice drugs—carbapenems and fluoroquinolones—has risen among key gram-negative bacteria, including Acinetobacter, Klebsiella pneumoniae, and Salmonella. “These antibiotics are critical for treating severe infections and their growing ineffectiveness is narrowing the treatment options,” said Dr. Yvan Hutin, who leads the WHO department of antimicrobial resistance.
Impact on Mortality and Health Systems
Global mortality related to drug-resistant infections was already substantial in 2021, with 7.7 million deaths from bacterial infections and AMR contributing to 4.71 million of them. The WHO’s data suggest that the death toll could rise further as resistant infections outpace the development and distribution of new drugs.
Policy and Practice: What Needs to Change
Experts stress that preventing infections and improving sanitation, water quality, and vaccination are essential components of a broader strategy. Equitable access to narrow-spectrum antibiotics, better diagnostics, and strengthened surveillance are critical to ensuring the right drugs reach the patients who need them. As Dr. Balasegaram of the Global Antibiotic Research and Development Partnership notes, the challenge is not only new antibiotics but ensuring they are targeted to the most impactful infections and accessible globally.
Strengthening surveillance—particularly in low-resource settings—alongside investments in research for novel therapies and improved stewardship could help avert a “tipping point” where treatment options become scarce. Experts also call for interdisciplinary research and accelerated innovation to keep pace with evolving resistance patterns.
Looking Ahead: A Call for Coordinated Action
To reverse this trajectory, public health leaders argue for comprehensive measures: better infection prevention and control, rapid diagnostic tools, vaccines that reduce infection risk, and policies that promote judicious antibiotic use. While new antibiotics are part of the solution, their development must be paired with strategies to ensure appropriate use and rapid, equitable distribution—especially in regions with the greatest burden of AMR.
Expert Perspectives
Dr Manica Balasegaram points to the need for a shift in focus from solely creating new drugs to ensuring those drugs reach patients who need them most. Prof Sanjib Bhakta underscores tailored global action and improved hygiene, water, and vaccination to curb transmission and resistance. All experts agree that a renewed, well-resourced commitment is required to prevent resistant infections from becoming the default in modern healthcare.
