The silent pandemic: understanding the global burden of antimicrobial resistance
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20261975Keywords:
Drug resistance, Microbial, Anti-bacterial agents, Global burden of diseases, One health, Vaccines and bacteriophagesAbstract
Antimicrobial resistance (AMR) is one of the most severe public health concerns of the 21st century and is reversing decades of progress made in the prevention and treatment of infectious diseases. AMR is a so-called "silent pandemic" since the condition progresses slowly and is completely unnoticed. But even AMR worldwide leads to considerable health, mortality and economic losses, with the most recent global report showing millions of such infectious diseases worldwide, and a very high number of deaths resulting from them, most of which are in the low- and middle-income countries. This review presents a global picture of AMR, clinical and public health-related issues along with key issues in terms of epidemiological surveillance, innovation and policy response. Factors driving the emergence and spread of resistance include the overuse and inappropriate use of antibiotics in human and animal health, poor infection control, substandard drugs, and environmental pollution. Also, we report that the health care sector is at significant risk due to AMR, which is a serious threat to the outcomes of routine surgeries, organ transplants, cancer treatment and the care of vulnerable patients. This in turn places substantial strain on health care systems. Worldwide and in different regions, monitoring programmes have been established that use genomics and Artificial Intelligence (AI) to study resistance pattern although they are still in a developing stage. Also, the development of new antibiotics in the pharma sector is a limited field, which in turn is pushing research into alternative options like phage therapy, nanotech-based solutions, Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) and vaccines that target priority pathogens. Although the World Health Organisation’s (WHO) Global Action Plan and national AMR strategies play a key role in shaping the international policy landscape for this issue, significant gaps still exist in implementation, regulation, financing and stewardship. The solution lies in better data collection on health issues, responsible use of antibiotics, infection control, innovation and sustained political commitment, which will not only slow down the AMR pandemic but also help secure the health of future generations.
References
Irfan M, Almotiri A, AlZeyadi ZA. Antimicrobial Resistance and Its Drivers—A Review. Antibiotics. 2022 ;11(10):1362.
Tang KWK, Millar BC, Moore JE. Antimicrobial Resistance (AMR). Br J Biomed Sci. 2023;80:11387.
Amann S, Neef K, Kohl S. Antimicrobial resistance (AMR). Eur J Hosp Pharm. 2019;26(3):175-7.
Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-55.
Naghavi M, Vollset SE, Ikuta KS, Swetschinski LR, Gray AP, Wool EE, et al. Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. Lancet. 2024;404(10459):1199-226.
Ho CS, Wong CTH, Aung TT, Lakshminarayanan R, Mehta JS, Rauz S, et al. Antimicrobial resistance: a concise update. Lancet Microbe. 2025;6(1):100947.
Ahmad N, Joji RM, Shahid M. Evolution and implementation of One Health to control the dissemination of antibiotic-resistant bacteria and resistance genes: A review. Front Cell Infect Microbiol. 2023;12:1065796.
Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015;109(7):309-18.
De Kraker MEA, Stewardson AJ, Harbarth S. Will 10 million People Die a Year due to Antimicrobial Resistance by 2050?. PLOS Med. 2016;13(11):e1002184.
Tiwaskar M, Vora A, Saraf A, Bhadade R, Choudhari S, Pawar D, et al. Defeating the Silent Enemy: Antimicrobial Resistance Looming as the Next Global Pandemic. J Assoc Physicians India. 2024;72(3):66-72.
Nature Communications Editorial. Antimicrobial resistance: a silent pandemic. Nat Commun. 2024;15(1):6198.
Reygaert WC. An overview of the antimicrobial resistance mechanisms of bacteria. AIMS Microbiol. 2018;4(3):482-501.
Blair JMA, Webber MA, Baylay AJ, Ogbolu DO, Piddock LJV. Molecular mechanisms of antibiotic resistance. Nat Rev Microbiol. 2015;13(1):42-51.
Munita JM, Arias CA. Mechanisms of antibiotic resistance. Microbiol Spectr. 2016;4(2):VMBF-0016-2015.
Kapoor G, Saigal S, Elongavan A. Action and resistance mechanisms of antibiotics: A guide for clinicians. J Anaesthesiol Clin Pharmacol. 2017;33(3):300.
Galia L, Ligozzi M, Bertoncelli A, Mazzariol A. Real-time PCR assay for detection of Staphylococcus aureus, Panton-Valentine leucocidin and methicillin resistance directly from clinical samples. AIMS Microbiol. 2019;5(2):138-46.
Hall CW, Mah TF. Molecular mechanisms of biofilm-based antibiotic resistance and tolerance in pathogenic bacteria. FEMS Microbiol Rev. 2017;41(3):276-301.
Adefisoye MA, Olaniran AO. Antimicrobial resistance expansion in pathogens: a review of current mitigation strategies and advances towards innovative therapy. JAC-Antimicrob Resist. 2023;5(6):dlad127.
AK, Bhardwaj R, Mishra P, Rajput SK. Antimicrobials Misuse/Overuse: Adverse Effect, Mechanism, Challenges and Strategies to Combat Resistance. Open Biotechnol J. 2020;14(1):107-12.
Sachithanandan JS, Deepalakshmi M, Rajamohamed H, Mary P, Mohankumar M, Vikashini S. Revolutionizing Antimicrobial Solutions Nanotechnology, CRISPR-Cas9 and Innovative Approaches to Combat Drug Resistance in ESKAPE Pathogens. J Pure Appl Microbiol. 2024;18(2):808-22.
Allel K, Day L, Hamilton A, Lin L, Furuya-Kanamori L, Moore CE, et al. Global antimicrobial-resistance drivers: an ecological country-level study at the human–animal interface. Lancet Planet Health. 2023;7(4):e291-303.
Salam MDA, Al-Amin MDY, Salam MT, Pawar JS, Akhter N, Rabaan AA, et al. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare. 2023;11(13):1946.
Peterson E, Kaur P. Antibiotic Resistance Mechanisms in Bacteria: Relationships Between Resistance Determinants of Antibiotic Producers, Environmental Bacteria, and Clinical Pathogens. Front Microbiol. 2018;9:2928.
Djordjevic SP, Jarocki VM, Seemann T, Cummins ML, Watt AE, Drigo B, et al. Genomic surveillance for antimicrobial resistance-a One Health perspective. Nat Rev Genet. 2024;25(2):142-57. Endale H, Mathewos M, Abdeta D. Potential Causes of Spread of Antimicrobial Resistance and Preventive Measures in One Health Perspective-A Review. Infect Drug Resist. 2023;16:7515-45.
Collignon P, Beggs JJ, Walsh TR, Gandra S, Laxminarayan R. Anthropological and socioeconomic factors contributing to global antimicrobial resistance: a univariate and multivariable analysis. Lancet Planet Health. 2018;2(9):e398-405.
Dadgostar P. Antimicrobial Resistance: Implications and Costs. Infect Drug Resist. 2019;12:3903-10.
OECD. Stemming the Superbug Tide: Just A Few Dollars More. OECD Publishing. 2018. Available at: https://www.oecd.org/en/publications/stemming-the-superbug-tide_9789264307599-en.html. Accessed on 04 January 2026.
Alem K, Dagnew M, Gizachew M, Gelaw B, Moges F. Environmental Antimicrobial Resistance: Key Drivers, Hotspots, Innovative Strategies, and Challenges in the Fight Against Superbugs. MicrobiologyOpen. 2025;14(5):e70067.
Van Boeckel TP, Brower C, Gilbert M, Grenfell BT, Levin SA, Robinson TP, et al. Global trends in antimicrobial use in food animals. Proc Natl Acad Sci. 2015;112(18):5649-54.
Van Boeckel TP, Pires J, Silvester R, Zhao C, Song J, Criscuolo NG, et al. Global trends in antimicrobial resistance in animals in low- and middle-income countries. Science. 2019;365(6459):eaaw1944.
Larsson DGJ, Flach CF. Antibiotic resistance in the environment. Nat Rev Microbiol. 2022;20(5):257-69.
Pezzani MD, Tornimbene B, Pessoa-Silva C, De Kraker M, Rizzardo S, Salerno ND, et al. Methodological quality of studies evaluating the burden of drug-resistant infections in humans due to the WHO Global Antimicrobial Resistance Surveillance System target bacteria. Clin Microbiol Infect. 202;27(5):687-96.
Werner CG, Sittner W, Wagner FD. Antimicrobial Resistance – The Silent Pandemic. J Artif Intell Mach Learn Data Sci. 2024;3(4):311-22.
Rayan RA. Flare of the silent pandemic in the era of the COVID-19 pandemic: Obstacles and opportunities. World J Clin Cases. 2023;11(6):1267-74.
Mami DM, Mami E. Unmasking the Silent Pandemic of Antimicrobial Resistance (AMR): A Comprehensive Review. Int J Pathog Res. 2025;14(4):59-70.
Akram F, Imtiaz M, Haq IU. Emergent crisis of antibiotic resistance: A silent pandemic threat to 21st century. Microb Pathog. 2023;174:105923.
Zhen X, Lundborg CS, Sun X, Hu X, Dong H. Economic burden of antibiotic resistance in ESKAPE organisms: a systematic review. Antimicrob Resist Infect Control. 2019;8(1):137.
Cosgrove SE. The Relationship between Antimicrobial Resistance and Patient Outcomes: Mortality, Length of Hospital Stay, and Health Care Costs. Clin Infect Dis. 2006;42(2):S82-9.
Allegranzi B, Bischoff P, De Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e276-87.
Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen JA, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. Lancet. 2016;387(10014):168-75.
Gupta YK, Srinivasan S. A Silent Pandemic of Antimicrobial Resistance: Challenges and Strategy for Preparedness in India. Ann Natl Acad Med Sci India. 2022;58:55-9.
Ashley EA, Recht J, Chua A, Dance D, Dhorda M, Thomas NV, et al. An inventory of supranational antimicrobial resistance surveillance networks involving low- and middle-income countries since 2000. J Antimicrob Chemother. 2018;73(7):1737-49.
Montagni I, Roussel N, Thiébaut R, Tzourio C. Health Care Students’ Knowledge of and Attitudes, Beliefs, and Practices Toward the French COVID-19 App: Cross-sectional Questionnaire Study. J Med Internet Res. 2021;23(3):e26399.
Pesesky MW, Hussain T, Wallace M, Patel S, Andleeb S, Burnham CAD, et al. Evaluation of Machine Learning and Rules-Based Approaches for Predicting Antimicrobial Resistance Profiles in Gram-negative Bacilli from Whole Genome Sequence Data. Front Microbiol. 2016;7:1887.
Theuretzbacher U, Gottwalt S, Beyer P, Butler M, Czaplewski L, Lienhardt C, et al. Analysis of the clinical antibacterial and antituberculosis pipeline. Lancet Infect Dis. 2019;19(2):e40-50.
Yosef I, Manor M, Kiro R, Qimron U. Temperate and lytic bacteriophages programmed to sensitize and kill antibiotic-resistant bacteria. Proc Natl Acad Sci. 2015;112(23):7267-72.
Pelgrift RY, Friedman AJ. Nanotechnology as a therapeutic tool to combat microbial resistance. Adv Drug Deliv Rev. 2013;65(14):1803-15.
Kortright KE, Chan BK, Koff JL, Turner PE. Phage Therapy: A Renewed Approach to Combat Antibiotic-Resistant Bacteria. Cell Host Microbe. 2019;25(2):219-32.
Poolman JT, Anderson AS. Escherichia coli and Staphylococcus aureus: leading bacterial pathogens of healthcare associated infections and bacteremia in older-age populations. Expert Rev Vaccines. 2018;17(7):607-18.
Klugman KP, Black S. Impact of existing vaccines in reducing antibiotic resistance: Primary and secondary effects. Proc Natl Acad Sci. 2018;115(51):12896-901.
Velazquez-Meza ME, Galarde-López M, Carrillo-Quiróz B, Alpuche-Aranda CM. Antimicrobial resistance: One Health approach. Vet World. 2022;743-9.
Årdal C, Outterson K, Hoffman SJ, Ghafur A, Sharland M, Ranganathan N, et al. International cooperation to improve access to and sustain effectiveness of antimicrobials. Lancet. 2016;387(10015):296-307.
Mendelson M, Røttingen JA, Gopinathan U, Hamer DH, Wertheim H, Basnyat B, et al. Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countries. Lancet. 2016;387(10014):188-98.
Huttner B, Saam M, Moja L, Mah K, Sprenger M, Harbarth S, et al. How to improve antibiotic awareness campaigns: findings of a WHO global survey. BMJ Glob Health. 2019;4(3):e001239.
Dalmolin TV, Wink PL, De Lima-Morales D, Barth AL. Low prevalence of the mcr-1 gene among carbapenemase-producing clinical isolates of Enterobacterales. Infect Control Hosp Epidemiol. 2019;40(2):263-4.
Dyar OJ, Huttner B, Schouten J, Pulcini C. What is antimicrobial stewardship?. Clin Microbiol Infect. 2017;23(11):793-8.
Walsh TR, Gales AC, Laxminarayan R, Dodd PC. Antimicrobial Resistance: Addressing a Global Threat to Humanity. PLOS Med. 2023;20(7):e1004264.
Knight GM, Glover RE, McQuaid CF, Olaru ID, Gallandat K, Leclerc QJ, et al. Antimicrobial resistance and COVID-19: Intersections and implications. eLife. 2021;10:e64139.
Hansen MA, Samannodi MS, Castelblanco RL, Hasbun R. Reply to Mathon et al. Clin Infect Dis. 2021;72(9):e433.
Luepke KH, Suda KJ, Boucher H, Russo RL, Bonney MW, Hunt TD, et al. Past, Present, and Future of Antibacterial Economics: Increasing Bacterial Resistance, Limited Antibiotic Pipeline, and Societal Implications. Pharmacother J Hum Pharmacol Drug Ther. 2017;37(1):71-84.