Scientists warn of increasing global antimicrobial resistance

Once seen as a lasting medical breakthrough, antibiotics are steadily losing their effectiveness. Around the world, infections that were once easy to treat are becoming harder to control. In some cases, they no longer respond to standard drugs. This growing threat, known as antimicrobial resistance, now challenges the foundation of modern healthcare.

A new review led by researchers from Jilin University and Peking Union Medical College Hospital brings together global surveillance data to explain how resistance is spreading and why it continues to accelerate. Published in the Medical Journal of Peking Union Medical College Hospital, the review examines resistant bacteria and fungi across regions, healthcare systems, and drug classes. It also outlines strategies that could slow the pace of resistance if adopted widely.

The research team analyzed data from international monitoring programs, including CARS, SENTRY, and One Health Trust–ResistanceMap. Their goal was to identify patterns that explain where resistance is rising fastest and which pathogens pose the greatest risk. The findings show a world divided. Some regions have managed to limit resistance through careful drug use and strong surveillance. Others face rapidly increasing rates, driven by weak regulation and heavy antibiotic exposure.

Modern medicine depends on the ability to treat infections quickly and reliably. Over decades, however, antibiotics have been used too often and sometimes without clear medical need. This has occurred in hospitals, outpatient clinics, and agriculture. As a result, bacteria and fungi have adapted, developing ways to survive drugs designed to kill them.

In many low and middle income regions, antibiotics can still be purchased without prescriptions. Limited laboratory testing also means doctors often rely on guesswork when choosing treatments. These factors allow resistant microbes to spread unnoticed. Global travel and food trade then carry those microbes across borders.

The review highlights how resistance patterns differ sharply between countries. Northern European nations often report low resistance rates, sometimes in the single digits. In contrast, parts of Asia, Africa, and Latin America report rates above 50 percent for common antibiotics. These gaps reflect differences in policy, healthcare access, and infection control.

Among bacterial threats, gram negative organisms stand out. Escherichia coli and Klebsiella pneumoniae remain leading causes of bloodstream, lung, and urinary infections. Many strains now produce enzymes that break down widely used antibiotics, including third generation cephalosporins.

The researchers found that resistance in these bacteria remains high worldwide. In some regions, more than half of tested strains no longer respond to standard treatments. Quinolone resistance in E. coli also exceeds 50 percent in many countries, reducing options for routine care.

Carbapenems, often considered last line antibiotics, are also losing ground. Carbapenem resistant Klebsiella pneumoniae has spread rapidly and is now classified as a critical priority pathogen. While resistance in E. coli remains lower, several countries report alarming increases over short periods.

Hospital settings face the highest burden. Intensive care units consistently report higher detection rates than general wards. Pediatric hospitals also show elevated resistance for certain pathogens, raising concerns for vulnerable patients.

Non fermenting gram negative bacteria present some of the most difficult challenges. Acinetobacter baumannii and Pseudomonas aeruginosa commonly cause hospital acquired infections and often resist multiple drug classes.

Carbapenem resistant Acinetobacter baumannii remains especially severe. In some regions, more than half of isolates show resistance, leaving few effective treatments. Pseudomonas aeruginosa shows more mixed trends. Some countries report declining resistance, while others continue to struggle.

These differences again point to national antibiotic policies and infection prevention efforts. Where stewardship programs are strong, resistance appears easier to control.

The review also addresses fungi, which receive less attention but pose serious risks. Invasive fungal infections affect millions each year and carry high death rates, especially among people with weakened immune systems.

Candida auris has emerged as a major concern. Many strains resist multiple antifungal drugs and spread easily in healthcare settings. Other Candida species also show rising resistance to azole drugs.

Aspergillus fumigatus presents a different problem. While many strains remain treatable, resistant isolates now appear in more than 20 countries. The authors note that agricultural fungicide use likely contributes to this trend, allowing resistance to develop outside hospitals.

The review explains several biological pathways that allow microbes to survive drugs. Bacteria often produce enzymes, such as extended spectrum beta lactamases and carbapenemases, that destroy antibiotics. Others use efflux pumps to push drugs out of their cells.

Resistance genes can also move between microbes through mobile genetic elements. This horizontal transfer allows resistance to spread quickly across species and environments. Agricultural antibiotic use plays a role by creating reservoirs of resistance genes that later appear in human infections.

Fungi rely on different tactics. Mutations can change drug targets, while biofilms protect fungal cells from treatment. Efflux systems also reduce drug levels inside fungal cells.

Despite the challenges, the authors stress that effective treatment remains possible. Success depends on choosing drugs based on infection severity, site, and local resistance data. Once laboratory results are available, therapy should be adjusted quickly.

For infections caused by resistant bacteria, newer beta lactam combinations are increasingly important. In severe cases, combination therapy may improve outcomes. Older drugs, such as polymyxins, remain options but require careful monitoring due to toxicity.

Fungal infections also demand tailored approaches. Echinocandins remain first line therapy for many Candida infections. Amphotericin B serves as an alternative when resistance is suspected. For invasive aspergillosis, azoles remain standard, with other drugs used when resistance appears.

"AMR represents a slow-moving pandemic," Xuesong Xu, lead author of the study told The Brighter Side of News. "Our review shows that resistance patterns are constantly shifting, shaped by human behavior, healthcare systems, and environmental factors. No country can fight this battle alone. What’s needed is a unified One Health strategy that bridges medicine, agriculture, and ecology. Only by strengthening surveillance, optimizing antibiotic use, and fostering innovation can we prevent a future where routine infections once again become deadly."

Research findings are available online in the Medical Journal of Peking Union Medical College Hospital.

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