WHO Reports Highest AMR in Countries with Weakest Health Systems

The World Health Organization (WHO) describes the increase in antimicrobial resistance (AMR), and particularly of Gram-negative bacterial pathogens, as a growing global threat, in the recently released 2025 report from its Global Antimicrobial Resistance and Use Surveillance System (GLASS).¹ "AMR is compromising the effectiveness of life-saving treatments, posing a serious, growing threat to global health and undermining the foundations of modern medicine," the report declares.

It offers the hopeful finding that there has been a four-fold increase in the number of countries participating in GLASS since its inception in 2016, allowing for generation of global estimates.Those estimates, however, are dire, with an increase in AMR in 40% of the pathogen-antibiotic combinations monitored between 2018 and 2023.There is particular notice of the increasing resistance to carbapenems and fluorqinolones among key Gram-negative pathogens, including Acinetobacter spp, E coli, K pneumoniae and Salmonella spp.

"This is a concern, as these antibiotics are essential for the treatment of severe infections. Rising AMR is limiting empirical therapeutic choices and driving a shift from oral to intravenous treatments, including greater reliance on second-choice and last-resort antibiotics," the report warns.

The GLASS investigators suggest that socioeconomic factors and the strength of countries' health systems are key determinants of BMR burden.Their analysis shows a strong inverse correlation between the universal health coverage service index (a measure of access to essential health services) and income, to the median percentage of AMR in bloodstream infections.

"This pattern points to a syndemic, in which AMR disproportionately affects countries with weaker health systems and lower income levels," they report.

The countries with limited surveillance are often those with higher resistance levels, according to the GLASS investigators, who call for strengthening laboratories and data systems across under-resourced regions.

They recommend three broad measures: Integrating surveillance into routine clinical practice and developing nationally representative AMR surveillance systems for both community-and hospital- acquired infections; Strengthening access to quality-assured diagnostics for bacteriology and mycology; Investing in robust digital information systems.

The disproportionate reliance on broad-spectrum antibiotics in these settings is the major driver of AMR, the report emphasizes.The WHO classifies antibiotics in the AwaRe framework as "Access," "Watch" and Reserve: for those that should be accessed as first-or second-choice for a wide range of common infections; watched for their higher resistance potential, and reserved for use as last resort, multi-drug resistant infections.

The report indicates that Access antibiotics comprised only 52.7% of global use in 2022; falling far short of the declaration of the United Nations General Assembly in 2024, that 70% of total antibiotics used in human health should be from the Access group by 2030.The report also finds that Watch antibiotics comprised 45.3% of global use, and exceeded 70% of antibiotics used in nearly one-third of countries.

The investigators find that, as resistance to lower-cost antibiotics such as third-generation cephalosporins rises, prescribing shifts to carbapenems, and then when resistance is encountered in Gram-negative pathogens, to the Reserve group of antibiotics.These, they note, are likely to be unaffordable and inconsistently available, and to require diagnostic confirmation that is rarely feasible in under-resourced regions.

"These patterns indicate an urgent need to strengthen antibiotic stewardship and ensure equitable access to effective essential antibiotics at all levels of care," the GLASS investigators declare.

Reference

1.WHO. Global Antibiotic Resistance Surveillance Report 2025. 2025, October 13. https://www.who.int/publications/i/item/9789240116337.