Antimicrobial Resistance (AMR) is a growing global health concern where microbes, such as bacteria, viruses, fungi, and parasites, develop the ability to withstand medicines. This makes infections challenging or impossible to treat, posing a serious threat to public health worldwide.
Understanding Antimicrobial Resistance
Antimicrobial resistance is a natural evolutionary process where microorganisms adapt over time, but human activities have significantly accelerated its development. Microbes acquire resistance through genetic mutations or by exchanging genetic material (horizontal gene transfer). These changes allow them to neutralize drugs, for example, by producing enzymes that break down the drug or modifying its target site.
For individuals, AMR leads to prolonged illnesses, increased mortality, and higher healthcare costs, often requiring more complex and toxic treatments with limited success. Beyond individual health, AMR jeopardizes modern medicine, making common procedures like surgeries, organ transplants, and cancer chemotherapy riskier due to untreatable infections. The spread of resistant microbes also threatens food security and global economic stability by impacting animal health and agricultural productivity.
Quantifying the Global Threat
The AMR threat is quantified through various metrics. Mortality rates are a primary indicator, with studies estimating the number of deaths directly attributable to AMR. For example, bacterial AMR was directly responsible for an estimated 1.27 million global deaths in 2019 and contributed to 4.95 million deaths in the same year.
Another metric is Disability-Adjusted Life Years (DALYs), which quantify the years of healthy life lost due to premature mortality and disability from AMR. While deaths attributable to AMR are projected to increase by nearly 70% from 2022 to 2050, DALYs are expected to show a smaller increase, reaching 46.5 million by 2050. The economic burden of AMR is substantial, encompassing increased healthcare costs, prolonged hospital stays, and lost productivity due to illness. In the European Union alone, drug-resistant bacteria are responsible for approximately 25,000 deaths annually, with associated healthcare costs and productivity losses amounting to at least €1.5 billion.
The prevalence of resistance in specific pathogens provides further insight into the global threat. Meticillin-resistant Staphylococcus aureus (MRSA) caused over 100,000 deaths directly attributable to AMR in 2019. Globally, the estimated annual number of people who developed multidrug-resistant tuberculosis (MDR-TB) was 410,000 in 2022.
These numbers are derived from surveillance systems, research, and modeling techniques. The World Health Organization’s (WHO) Global Antimicrobial Resistance and Use Surveillance System (GLASS) provides a standardized approach for collecting national AMR data. Active surveillance through periodic national prevalence surveys offers reliable, direct measurements. However, global surveillance systems remain somewhat disconnected, and many nations lack necessary laboratory and data management capacities, leading to reliance on modeling to fill data gaps.
Factors Driving Resistance
Several interconnected factors accelerate the development and spread of antimicrobial resistance. A major driver is the misuse and overuse of antimicrobials in human medicine. This includes prescribing antibiotics for viral infections, against which they are ineffective, and patients not completing their full course of treatment, allowing stronger bacteria to survive and multiply. Such practices create selective pressure, favoring resistant strains.
Similarly, the misuse of antimicrobials in agriculture and animal husbandry contributes significantly. These drugs are used for growth promotion or disease prevention in healthy animals, not just for treating infections. This widespread use in food production increases bacterial exposure to antimicrobials, fostering resistance.
Poor infection prevention and control practices in healthcare settings and communities also play a substantial role in the spread of resistant microbes. Inadequate hygiene, insufficient sanitation, and a lack of proper waste management allow resistant bacteria to transmit easily between individuals and environments. Global travel and trade further facilitate the rapid dissemination of resistant strains across borders, making AMR a truly international challenge.
Addressing the Challenge Globally
Addressing the complex challenge of antimicrobial resistance requires a coordinated, multi-sectoral approach. The “One Health” concept emphasizes the interconnectedness of human, animal, and environmental health, requiring collaborative efforts. This integrated approach recognizes that resistant organisms spread through healthcare, animals, food, and the environment, necessitating multifaceted interventions.
Global initiatives and frameworks guide these collective actions, with the WHO Global Action Plan on AMR, endorsed in May 2015, serving as a foundational document. This plan outlines five strategic objectives:
Improving awareness.
Strengthening knowledge through surveillance and research.
Reducing infection incidence.
Optimizing antimicrobial use.
Ensuring sustainable investment.
National action plans are developed by countries in alignment with this global framework.
Key Strategies
Key strategies include:
Strengthening surveillance and research to track resistance patterns and understand emerging threats.
Promoting responsible use of antimicrobials (antimicrobial stewardship) to optimize treatment in human and animal health.
Investing in research and development of new drugs, vaccines, and diagnostic tools.
Public awareness campaigns and education to encourage appropriate antimicrobial use and hygiene.