New WHO Reports Sounds Alarm on Antimicrobial Resistance

Global Antibiotic Resistance Surveillance 2025 is the most extensive report yet from the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS).1 As of year-end 2024, 127 countries and 3 territories have joined the GLASS initiative, whose goal is to support countries in their efforts to monitor antimicrobial resistance, strengthen belief in treatment effectiveness, and support the health of millions around the world.

According to the CDC, antimicrobial resistance is the result of germs being able to outlast the treatments meant to eradicate them and is now one of the world’s “most urgent public health problems.”2 These resistant germs then lead to resistant infections that become increasingly difficult, or impossible, to treat. As recently as 2019, antimicrobial resistance has been associated with approximately 5 million total global deaths, and in the US alone, more than 2.8 million such annual infections.

The new report covers 93 infection type–pathogen–antibiotic combinations on regional and global bases, national prevalence estimates, regional and global resistance trends; and both progress against and challenges to worldwide surveillance efforts. Among the most pressing issues it highlights are that resource-limited settings are seeing an alarming rise in their already elevated levels of resistance to live-saving medications, notes Yukiko Nakatani, assistant director–general, health systems access and data, World Health Organization.

“Such inequalities underline the urgent need to address [antimicrobial resistance] by investing in health systems,” she emphasizes, “especially to prevent infections and to ensure access to timely, high-quality, affordable, appropriate diagnosis and treatment.”

The new report from the WHO Global Antimicrobial Resistance and Use Surveillance System is its most extensive, with estimates for 93 infection type–pathogen–antibiotic combinations. | Image Credit: © dizain-stock.adobe.com

Some of the countries and territories that contributed to the report are Afghanistan, Bangladesh, Croatia, Democratic People’s Republic of Korea, Ethiopia, Greece, Indonesia, Kenya, Malawi, Netherlands, Philippines, Qatar, Rwanda, South Africa, Tunisia, US, and Zimbabwe. Overall, the reporting participation rate has quadrupled in less than 10 years, since 2016, but persistent gaps remain.

As of 2023, there were significant differences in participation among member states in reporting data to GLASS: 20.0% for the Americas vs 37.0% of the Western Pacific Region vs 57.4% of Africa vs 58.5% of Europe vs 76.2% of the Eastern Mediterranean vs 90.9% (the highest) of South-East Asia. In addition, just 46.2% of participating countries had instituted all WHO-recommended core surveillance components, only 53.8% of countries exhibited national data completeness, and there are sizeable sections of sub-Saharan Africa and Central Asia that report little to no data to GLASS.

Global resistance is extensive, and these variations are great, too. Overall, median resistance was most common for urinary tract and bloodstream infection and less common for gastrointestinal and urogenital gonorrhoeal infections. Southeast Asia and the Eastern Mediterranean regions reported the highest resistance rates (31.1% and 30.0%, respectively) and the European and Western Pacific regions (10.2% and 9.1%, respectively), the lowest resistance rates. In comparison, the overall global rate is 17.2%.

There also is an increasing threat from Gram-negative pathogens. These types of bacteria are considered more dangerous because of their additional outer protective membrane and their larger concentrations of transport proteins that force drugs out of cells.3 Forty percent of the pathogen–antibiotic combinations monitored between 2018 and 2023 demonstrated increased antimicrobial resistance, while annual rates of this fluctuated between 5% and 15%. Some of the Gram-negative pathogens of note are Acinetobacter spp., Escherichia coli, Klebsiella pneumoniae, and Salmonella spp, principally because of their increasing resistance to carbapenems and fluoroquinolones.

“This is a concern,” the WHO reports says, “as these antibiotics are essential for the treatment of severe infections.”

Key social determinants implicated in the disproportionate impact of antimicrobial resistance are universal health coverage service coverage index, income classification, and median percentage of antimicrobial resistance in bloodstream infections. This burden is demonstrably higher in low- and middle-income countries that have weaker health systems and limited diagnostic capacity, as well as a lack of effective and essential antibiotics.

Among the policy recommendations for action:

• Improve the coverage and representativeness of antimicrobial resistance surveillance systems
• Implement integrated infection prevention efforts that cover water, sanitation, hygiene, vaccination, and antimicrobial stewardship
• Invest more in research and development of new antibiotics
• Scale up diagnostic efforts for targeted antibiotic therapies
• Invest in digital information systems

References

1. August OT. Global antibiotic resistance surveillance report 2025: WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS). World Health Organization. 2025. Accessed October 13, 2025. https://www.who.int/publications/i/item/9789240116337
2. About antimicrobial resistance. CDC. January 31, 2025. Accessed October 13, 2025. https://www.cdc.gov/antimicrobial-resistance/about/index.html
3. Why are Gram negative bacteria harder to kill due to antibiotic resistance? Crestone. September 22, 2022. Accessed October 13, 2025. https://crestonepharma.com/why-are-gram-negative-bacteria-harder-to-kill-with-antibiotics/