Global Antibiotic Resistance Crisis

Antibiotic resistance threatens modern medicine as the WHO reports that 1 in 6 infections are resistant to treatment. Learn about the global crisis and response strategies.

Global Antibiotic Resistance Crisis Reaches Critical Levels, WHO Warns

Antibiotic resistance has escalated to alarming levels worldwide, threatening to reverse a century of medical progress. According to the World Health Organization’s groundbreaking 2025 report, one in six laboratory-confirmed bacterial infections globally were resistant to antibiotic treatments in 2023. This antibiotic resistance crisis affects both common and severe infections, making standard treatments increasingly ineffective and putting millions of lives at risk.

The WHO’s Global Antibiotic Resistance Surveillance Report 2025 represents the most comprehensive analysis of this growing threat to date. The data paints a concerning picture of rapidly evolving bacterial defenses against our most important medical weapons. Between 2018 and 2023, antibiotic resistance increased in more than 40% of the pathogen-antibiotic combinations monitored by WHO, with an average annual increase of 5-15% across these combinations.

“Antimicrobial resistance is outpacing advances in modern medicine, threatening the health of families worldwide,” warned Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “As countries strengthen their AMR surveillance systems, we must use antibiotics responsibly, and make sure everyone has access to the right medicines, quality-assured diagnostics, and vaccines”.

Understanding the Scale of the Global Antibiotic Resistance Crisis

The statistics revealed in the report underscore the dramatic progression of the antibiotic resistance problem. The analysis draws from a massive dataset of more than 23 million bacteriologically confirmed cases of bloodstream infections, urinary tract infections, gastrointestinal infections, and urogenital gonorrhoea. This information was reported by 104 countries in 2023 and 110 countries between 2016 and 2023, providing an unprecedented view of global resistance patterns.

The report provides adjusted global and regional estimates of antimicrobial resistance for 93 different infection type-pathogen-antibiotic combinations. This level of detail helps healthcare providers, policymakers, and researchers understand the specific threats in different regions and clinical contexts. Additionally, the report tracks global and regional resistance trends for 16 key combinations between 2018 and 2023, revealing disturbing upward trajectories in many cases

Regional Disparities in Antibiotic Resistance Burden

The burden of antibiotic resistance is not distributed evenly across the globe. The WHO report identifies striking regional variations that highlight the complex interplay between healthcare infrastructure, resource allocation, and resistance development:

• Highest Resistance Rates: The WHO South-East Asian and Eastern Mediterranean Regions experience the highest resistance rates, where approximately one in three reported infections were resistant to antibiotic treatment in 2023.
• African Region Challenges: In the African Region, one in five infections demonstrated resistance, with particularly alarming rates exceeding 70% for both E. coli and K. pneumoniae resistance to third-generation cephalosporins in some areas.
• Comparative Lower Rates: European regions reported approximately one in ten infections as resistant to antibiotics, significantly lower than the global average, but still concerning.

Dr. Yvan Hutin, director of the WHO’s antimicrobial resistance department, emphasized the inequality of this distribution: “Antibiotic resistance is not only widespread and increasing, but it’s also unevenly distributed across the globe”. He further noted that “simply put, the less people have access to quality care, the more they’re likely to suffer from drug-resistant infections”.

Table: Regional Antibiotic Resistance Prevalence (2023)

Gram-Negative Bacteria: The Greatest Antimicrobial Threat

The WHO report singles out drug-resistant Gram-negative bacteria as particularly dangerous components of the antibiotic resistance crisis. These pathogens, characterized by their protective outer membrane that makes them more difficult to treat, are becoming increasingly resistant to multiple antibiotic classes.

Among these concerning Gram-negative bacteria, Escherichia coli (E. coli) and Klebsiella pneumoniae are identified as leading causes of drug-resistant bloodstream infections. These infections rank among the most severe bacterial illnesses, frequently resulting in sepsis, organ failure, and death. The data reveal that more than 40% of E. coli and over 55% of K. pneumoniae globally are now resistant to third-generation cephalosporins, which represent the first-choice treatment for these serious infections.

The situation is even more dire in specific regions. Throughout the WHO African Region, resistance to these critical first-line antibiotics exceeds 70% for both pathogens, dramatically limiting treatment options and worsening patient outcomes.

Resistance Trends Across Different Infection Types

Bloodstream Infections and Antibiotic Resistance
Bloodstream infections represent one of the most serious manifestations of the antibiotic resistance crisis. The WHO report documents disturbing resistance patterns in these life-threatening conditions:

MRSA Prevalence: Methicillin-resistant Staphylococcus aureus (MRSA) remains a persistent challenge, affecting 27.1% of bloodstream infections globally.

E. coli Resistance: 44.8% of E. coli bloodstream infections showed resistance to third-generation cephalosporins.

K. pneumoniae Resistance: 55.2% of K. pneumoniae bloodstream infections were resistant to these first-line antibiotics.

Acinetobacter Resistance: Perhaps most alarming, 54.3% of Acinetobacter bloodstream infections demonstrated resistance to carbapenems, last-resort antibiotics reserved for the most stubborn infections.

Urinary Tract Infections and Antibiotic Resistance

Urinary tract infections (UTIs), among the most common bacterial infections worldwide, particularly affect women and are becoming increasingly difficult to treat due to antibiotic resistance. The report indicates that resistance to first-line antibiotics in UTIs caused by E. coli and K. pneumoniae typically exceeds 30% in most countries.

This rising resistance in UTIs poses a particular burden on women’s health globally, as these infections become more challenging and expensive to treat, sometimes requiring hospitalization and intravenous antibiotics when oral options fail.

Gastrointestinal and Sexually Transmitted Infections

The antibiotic resistance crisis extends to gastrointestinal infections and sexually transmitted diseases:

• Gastrointestinal Infections: Displayed comparatively lower resistance levels at approximately 1 in 15 infections.
• Urogenital Gonorrhea: Demonstrated the lowest resistance levels at 1 in 125 infections, but with concerning patterns emerging.
• Gonorrhea Treatment Concerns: While resistance to the standard treatment ceftriaxone remains low, gonorrhea shows near-universal resistance to fluoroquinolones (75%), eliminating this class as a treatment option. Emerging ceftriaxone resistance could jeopardize the last reliable therapy for gonorrhea.

The Accelerating Pace of Antibiotic Resistance Development

The WHO report tracks resistance trends over a critical five-year period from 2018 to 2023, revealing an accelerated development of antibiotic resistance across multiple pathogen-drug combinations. During this period, antibiotic resistance rose in over 40% of the monitored combinations.

The most significant increases occurred among Gram-negative bacteria, including E. coli, K. pneumoniae, and Acinetobacter species, with some combinations showing annual resistance increases of up to 15%. This rapid acceleration underscores the adaptive capacity of bacterial pathogens and the urgent need for coordinated global action.

Of particular concern is the spread of resistance to “Watch” antibiotics – broad-spectrum agents that WHO has determined should be used selectively for more severe infections due to their importance and resistance potential. The erosion of these critical tools narrows treatment options for severe infections and complicates clinical decision-making.

Global Response and Surveillance Improvements

Progress in AMR Surveillance Systems

Despite the concerning findings, the WHO report highlights significant progress in global surveillance capabilities for monitoring antibiotic resistance:

• Increased Participation: Country participation in the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) has risen fourfold, from just 25 countries in 2016 to 104 countries in 2023.
• Population Coverage: The 104 countries that submitted data in 2023 represent approximately 70% of the world’s population, providing a more comprehensive picture of global resistance patterns than ever before.
• Data Quality Improvements: More countries are reporting antimicrobial susceptibility test (AST) results, indicating either more frequent testing in clinical care or expansion of testing to additional healthcare facilities.

“The upward trend in participation in GLASS reflects increased awareness in countries of the value of global data-sharing as a common public health good,” said Silvia Bertagnolio, MD, head of the WHO’s AMR surveillance, evidence, and laboratory strengthening unit.

Persistent Surveillance Gaps and Challenges

Despite these improvements, significant gaps remain in global antibiotic resistance surveillance:

• Limited Reporting: 48% of countries did not report data to GLASS in 2023, leaving substantial blind spots in the global resistance map.
• Systemic Challenges: Approximately half of reporting countries still lacked the systems to generate reliable, representative data. Countries facing the largest AMR challenges often had the most limited surveillance capacity.
• Regional Disparities: Participation remains uneven, with the Americas and Western Pacific regions showing the lowest engagement. Many countries in sub-Saharan Africa, Latin America, and the Western Pacific provide limited or no data to GLASS.
• Infrastructure Limitations: Global data completeness for AMR surveillance remains at just 53.8%, highlighting major gaps in representativeness, particularly in low-resource settings.

Consequences of Worsening Antibiotic Resistance

The implications of escalating antibiotic resistance extend far beyond infectious disease treatment, threatening multiple aspects of modern medicine:

• Routine Procedures at Risk: Common medical procedures, including surgery, chemotherapy, organ transplantation, and childbirth, could become significantly more dangerous as prophylactic antibiotic protection fails.
• Mortality Projections: Antimicrobial resistance already contributes to millions of deaths annually. Without effective intervention, AMR-related deaths are expected to increase by 70% by 2050, according to experts.
• Economic Impact: The World Bank estimates that AMR could cause $1 trillion in additional healthcare costs by 2050, with $1 trillion to $3.4 trillion gross domestic product losses per year by 2030.
• Health Equity Concerns: The disproportionate impact of AMR on low and middle-income countries threatens to widen global health disparities, as effective treatments become increasingly scarce and expensive.

Global Action Framework and Response Strategies

WHO Recommendations for Addressing Antibiotic Resistance

The WHO report outlines a comprehensive framework for addressing the antibiotic resistance crisis, emphasizing coordinated action across multiple sectors:

• Strengthened Surveillance: Countries must improve the coverage and representativeness of AMR surveillance systems, with a target of all countries reporting high-quality data to GLASS by 2030.
• Infection Prevention: Scaling up infection prevention and control measures in healthcare facilities, together with improved water, sanitation, and hygiene in communities, can reduce the transmission of resistant pathogens.
• Antimicrobial Stewardship: Promoting appropriate use of antibiotics across human and animal health, including increasing Access to antibiotics to at least 70% of consumption by 2030, is critical for preserving effectiveness.
• Research and Development: Increased investment in novel antibiotics, particularly those targeting critical Gram-negative pathogens, along with rapid diagnostic tests and vaccines, is urgently needed.

One Health Approach to Antibiotic Resistance

The WHO emphasizes that addressing antibiotic resistance requires a “One Health” approach that coordinates actions across human health, animal health, and environmental sectors. This integrated recognition acknowledges that resistant bacteria and resistance genes can circulate among humans, animals, and the environment.

The Quadripartite organizations – comprising the Food and Agriculture Organization (FAO), the United Nations Environment Program (UNEP), the World Health Organization (WHO), and the World Organization for Animal Health (WOAH) – are jointly supporting countries in implementing this comprehensive approach through initiatives like the Tracking AMR Country Self-Assessment Survey (TrACSS).

Regional Roadmaps for Action

To support context-specific interventions, WHO has developed regional roadmaps such as the “Regional Roadmap to accelerate actions on antimicrobial resistance in the human health sector in the South-East Asia Region (2025–2030).” This guide helps countries upgrade their AMR responses based on local data, health system capacity, and people-centered principles.

These roadmaps provide a stepwise method to improve implementation, prioritize actions, and track progress toward stronger health systems and reduced AMR impact by 2030.

The Future of Antibiotic Resistance and Global Health

The WHO report serves as both a warning and a call to action on antibiotic resistance. While the findings are deeply concerning, the expanding global surveillance network provides reason for hope that coordinated, evidence-based action can mitigate the worst impacts of this crisis.

Dr. Manica Balasegaram at the Global Antibiotic Research and Development Partnership noted that the report adds to evidence that drug-resistant infections have reached “a critical tipping point.” He emphasized that “the most difficult-to-treat gram-negative infections are now beginning to outpace antibiotic development, either because the right antibiotics are not reaching the people who need them, or because they are not being developed in the first place”.

Professor Sanjib Bhakta, who works on drugs to tackle AMR at University College London and Birkbeck, University of London, stressed that combating AMR requires “tailored global action” from strengthening surveillance and diagnostics to ensuring equitable access to narrow-spectrum antibiotics. “Crucially, renewed investment is needed to support interdisciplinary, blue-sky research aimed at discovering novel therapeutic interventions against drug-resistant bacteria,” he said.

Conclusion: The Critical Need for Immediate Action on Antibiotic Resistance

The WHO Global Antibiotic Resistance Surveillance Report 2025 presents compelling evidence that antibiotic resistance has escalated into a global health crisis requiring urgent, coordinated action. With one in six bacterial infections now resistant to treatment, and resistance increasing at 5-15% annually for many critical pathogen-drug combinations, the time for decisive action is now.

The disproportionate impact on low and middle-income countries, particularly those with weaker health systems, highlights the connection between antibiotic resistance and health equity. Addressing this crisis requires not only technical solutions but also political commitment and financial investment to ensure that all countries can mount an effective response.

The upcoming years represent a critical window to implement the comprehensive strategies outlined by the WHO and partner organizations. Through strengthened surveillance, coordinated interventions across human and animal health, responsible antibiotic use, and accelerated innovation, the global community can work to preserve these essential medicines for future generations. The alternative – a post-antibiotic era where common infections once again become deadly – remains unthinkable but increasingly possible without immediate action.