Rising antibiotic resistance is pushing routine infections back into the danger zone

A new WHO analysis reveals accelerating resistance to serious pathogens and widening global inequalities and calls on countries to step up surveillance, expand access to essential antibiotics and act now before common infections become untreatable.

Global Antibiotic Resistance Surveillance Report 2025. Image credit: Kateryna Kon / Shutterstock

in recent reports from AMR Department of world health organization (who), scientists discussed the results of global efforts for surveillance. antibiotic resistance. Their findings highlighted that levels of antibiotic resistance are consistently high and uneven around the world, with wide disparities between regions. Countries with low incomes and weak diagnostic and surveillance infrastructure are unable to invest in systematic monitoring and are disproportionately affected.

countering global threats

AMR They pose a growing global health threat that reduces the effectiveness of life-saving treatments and undermines modern medicine. of who Established a global antimicrobial resistance and use monitoring system (glass) Collect and analyze standardized information in 2015 AMR data and was subsequently expanded to include antibiotic use in 2020 (Amu). The 2025 report is based on model estimates from more than 23 million bacteriologically confirmed infections in 104 countries, covering 22 antibiotics and eight major bacterial pathogens.

These estimates account for variations in population and surveillance coverage and provide adjusted national, regional, and global resistance patterns. The report also introduces a structured scoring framework to assess national maturity and completeness. AMR surveillance system.

Global rollout of AMR surveillance

From 2016, glass It has grown four times, with 127 countries registering and 104 submitting. AMR The data currently covers over 70% of the world's population. The number of infections evaluated for antimicrobial susceptibility is increasing, particularly for urinary tract infections, bloodstream infections, and gastrointestinal infections, indicating that broader surveillance is becoming more prevalent.

However, participation remains uneven across regions. Engagement is lowest in the Americas and Western Pacific, with only about half of reporting countries having all the key elements of surveillance in place. Global data completeness stands at just 53.8%, highlighting significant gaps in representativeness. Many low-resource countries still lack adequate testing infrastructure and automated or molecular testing, limiting both data quality and treatment guidance.

Wide range of non-uniform resistance patterns

In 2023, approximately 17.2% of laboratory-confirmed bacterial infections worldwide involved antibiotic-resistant pathogens. This equates to approximately 1 in 6 cases when assessed across infection, pathogen, and antibiotic combinations, although the burden varies widely by type of infection. Urinary tract and bloodstream infections showed the highest resistance, while gastrointestinal infections showed relatively low resistance.

Resistance levels were highest in Southeast Asia and the eastern Mediterranean (approximately one-third of combinations) and lowest in the western Pacific (approximately one-eleventh of combinations). Common gram-negative pathogens include: they showed coldness and Klebsiella pneumoniaeshowed widespread resistance to third-generation cephalosporins and fluoroquinolones, with resistance rates exceeding 70% in some African environments. Of particular concern was resistance to carbapenems. Acinetobacter The global rate is 54.3%. Methicillin resistance Staphylococcus aureus (MRSA) remained prevalent, affecting 27.1% of bloodstream infections.

Gonorrhea infections have shown near universal resistance (75%) to fluoroquinolones, but ceftriaxone resistance remains low. The report warns that the emergence of ceftriaxone resistance could jeopardize the last reliable empirical treatment for gonorrhea.

Rising AMR trends and systemic inequalities

Between 2018 and 2023, AMR Increased in 40% of monitored pathogen-antibiotic combinations, with the fastest increases occurring in Gram-negative bacteria, including: Escherichia coli, Klebsiella pneumoniaeand Acinetobacter spp., increasing by up to 15% per year. Resistance to carbapenems and fluoroquinolones increasingly limits treatment options, forcing reliance on expensive intravenous medications and last-resort antibiotics.

Countries with limited surveillance capacity reported the highest levels of resistance, reflecting syndemic interactions between the two countries. AMR and a fragile health system. Many observations are influenced by selective sampling in tertiary hospitals where the most severe cases are tested, which may inflate estimates of resistance.

Low- and middle-income countries (LMIC) carry a disproportionate burden, and inadequate diagnosis and overreliance on watch antibiotics promote resistance. In 2022, access antibiotics accounted for just 52.7% of global usage, well below the 2030 target of 70%, while watch antibiotics accounted for 45.3%, indicating poor management.

Priorities to strengthen global action

Countries now need to accelerate efforts to strengthen national surveillance systems, ensure complete and representative data, and provide regular public reporting by 2030. who Encourage investment in testing capacity, digital platforms, and the integration of surveillance into national decision-making, particularly in underrepresented and high-burden areas.

To combat escalating Gram-negative resistance, countries must reduce the use of watch antibiotics, increase the use of access antibiotics to at least 70% by 2030, and expand equitable access to reserve agents. It is essential to scale up diagnostic, infection prevention, hygiene, vaccination, and control programs.

as AMR disproportionately affect LMICthe government must embed AMR Control within broader strategies for universal health coverage, health system strengthening, and health equity. Sustained domestic investment, supported by global financing mechanisms, is essential for long-term resilience.

conclusion

Addressing trends and inequities in antibiotic resistance requires strong surveillance, improved diagnostic capacity, context-specific interventions, and equitable access to effective antibiotics. If we don't take immediate action, AMR It threatens to undermine decades of medical progress.