Hospitals across the world have recorded an alarming rise in common infections that are resistant to antibiotics, with doctors saying the number of deaths driven by drug resistance will increase sharply in the years ahead.
One in six laboratory-confirmed bacterial infections were resistant to antibiotic treatments in 2023, with more than 40% of antibiotics losing potency against common blood, gut, urinary tract and sexually-transmitted infections between 2018 and 2023, records show.
The problem was most severe, and worsening, in low and middle-income countries and those with weaker healthcare systems, according to the World Health Organization’s Global Antibiotic Resistance Surveillance report, which gathered data on more than 23m bacterial infections from 104 countries.
“These findings are deeply concerning,” said Dr Yvan Hutin, the director of the WHO’s department of antimicrobial resistance. “As antibiotic resistance continues to rise, we are running out of treatment options and we are putting lives at risk, especially in countries where infection prevention and control is weak and access to diagnostics and effective medicine is already limited.”
Estimates of resistance for some countries might be skewed by healthcare systems reporting data only from specialist hospitals that handle the most severe infections. But based on the records gathered, the WHO estimates one in three bacterial infections in south-east Asia and the eastern Mediterranean were resistant to antibiotics in 2023, and one in five in Africa.
Antimicrobial resistance (AMR) arises when pathogens evolve to withstand the drugs used to kill them. In 2021, 7.7 million people globally died from bacterial infections. Drug resistance contributed to 4.71 million of the deaths, with 1.14 million directly attributed.
The report raises serious concerns about gram-negative bacteria – those protected by an outer shell – such as Escherichia coli and Klebsiella pneumoniae, which cause some of the most severe bacterial infections that often lead to sepsis, organ failure and death.
Hutin said 40% of E coli and more than 55% of K pneumoniae are resistant to third-generation cephalosporins, the first choice treatment for such infections. In the WHO African region, resistance often exceeds 70%, he said.
Resistance to critical second-choice antibiotics, particularly carbapenems and fluoroquinolones, was also rising among key gram-negative bacteria such as Acinetobacter, K pneumoniae and salmonella, the report found. “These antibiotics are critical for treating severe infections and their growing ineffectiveness is narrowing the treatment options,” Hutin said.
Dr Manica Balasegaram at the Global Antibiotic Research and Development Partnership said the report added to evidence that drug-resistant infections had reached “a critical tipping point”.
“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,” he said. “As a result, the number of AMR deaths is now expected to rise sharply, increasing by 70% by 2050.
“It’s not enough to develop new antibiotics, they have to be the right ones, those that target infections that have the greatest public health impact. We are failing to replace the antibiotics that are being lost to resistance, and this latest WHO report shows that the consequences of that are now finally beginning to be felt.
“Until now, the AMR narrative has focused rightfully on the overuse of antibiotics, but this isn’t enough. To avoid the tipping point, we must now also focus efforts on accelerating innovation and increasing their appropriate use.”
Prof Sanjib Bhakta, who works on drugs to tackle AMR at University College London, said the WHO report revealed “an alarming escalation in resistance”, particularly among gram-negative bacteria.
He said combating AMR required “tailored global action” from strengthening surveillance and diagnostics to ensuring equitable access to narrow-spectrum antibiotics. Preventing infections was also important through cleaner water, better sanitation and hygiene and vaccination.
“Crucially, renewed investment is needed to support interdisciplinary, blue-sky research aimed at discovering novel therapeutic interventions against drug-resistant bacteria,” he said.
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