Global Antibiotic Resistance Surveillance Report 2025

The Global Antibiotic Resistance Surveillance Report 2025, published by the World Health Organization (WHO) on 13 October 2025, represents the most detailed global assessment of antimicrobial resistance (AMR) to date under the Global Antimicrobial Resistance and Use Surveillance System (GLASS). Analysing over 23 million bacteriologically confirmed infections across 104 countries, covering approximately 70% of the world’s population, the report examines eight key bacterial pathogens and 22 antibiotics across bloodstream, urinary tract, gastrointestinal, and gonorrhoeal infections. It highlights AMR as a mounting public health emergency that threatens to undermine routine medical treatments and projects a 70% increase in AMR-related deaths by 2050 if urgent measures are not implemented.

Background and Global Context

Antimicrobial resistance arises when bacteria evolve mechanisms to survive exposure to antibiotics that would normally kill them or inhibit their growth. This phenomenon compromises the effectiveness of standard treatments, leading to prolonged illness, higher healthcare costs, and increased mortality. The 2025 WHO report emphasises that Gram-negative bacteria—particularly Escherichia coli, Klebsiella pneumoniae, and Acinetobacter species—pose the gravest threat, given their role in severe infections such as sepsis and organ failure.
The report also assesses resistance patterns within the AWaRe antibiotic classification, which categorises drugs into:

• Access (first-line treatments such as co-trimoxazole);
• Watch (broad-spectrum agents including third-generation cephalosporins and fluoroquinolones);
• Reserve (last-resort antibiotics such as carbapenems).

Resistance to Watch and Reserve antibiotics is rising rapidly, especially in low- and middle-income countries (LMICs), where access to reliable diagnostics and regulated antimicrobial use remains limited.

Key Findings and Resistance Rates

According to data from 2023, one in six laboratory-confirmed bacterial infections globally was resistant to at least one antibiotic. Across 93 pathogen–antibiotic combinations, the median global resistance rate stood at 17.2%, with an interquartile range of 3.5–39.5%. Resistance was most prevalent in urinary tract infections (one in three cases), followed by bloodstream infections (one in six), gastrointestinal infections (one in fifteen), and gonorrhoeal infections (one in 125).
The following global estimates for bloodstream infections illustrate the scope of the challenge:

• Escherichia coli: Resistance to third-generation cephalosporins reached 44.8%, exceeding 70% in African nations.
• Klebsiella pneumoniae: Resistance to the same antibiotic class stood at 55.2% globally and over 70% in Africa; carbapenem resistance was as high as 41.2% in Southeast Asia.
• Acinetobacter spp.: Carbapenem resistance averaged 54.3%, with some hospital-based studies reporting levels up to 71%.
• Staphylococcus aureus (MRSA): Methicillin resistance, tracked as a Sustainable Development Goal indicator, was identified in 23.2% of bloodstream infections.
• Neisseria gonorrhoeae: Resistance remained comparatively low (around one in 125 infections), but continued vigilance is required due to the pathogen’s history of rapid adaptation.

In urinary tract infections, first-line antibiotic resistance exceeded 30% in most countries for E. coli and K. pneumoniae. Gastrointestinal infections, particularly those caused by non-typhoidal Salmonella species, accounted for 83.5% of AMR cases within that category.
Globally, bacterial infections were responsible for 7.7 million deaths in 2021, with AMR contributing to 4.71 million of these and directly causing approximately 1.14 million deaths.

Temporal Trends and Emerging Patterns

Between 2018 and 2023, resistance increased across more than 40% of pathogen–antibiotic combinations, with annual growth rates ranging between 5% and 15%. Surveillance coverage expanded notably during this period, with urinary tract infection monitoring increasing by 26% annually and bloodstream infection surveillance by 20%.
Participation in GLASS has quadrupled since 2016, reflecting growing international commitment to data transparency. However, WHO cautions that data quality and geographical coverage remain uneven, leading to potential overestimation of resistance levels in regions where only tertiary hospital data are available.
A concerning trend is the accelerated resistance to Watch antibiotics, which are essential for treating severe infections. As these options become compromised, health systems are increasingly forced to rely on Reserve antibiotics—drugs that are both costly and often unavailable in resource-poor settings. The rise in carbapenem-resistant Gram-negative bacteria underscores this crisis, signalling a potential return to a pre-antibiotic era in some regions.

Regional Variations and Inequities

AMR prevalence varies markedly by region and correlates strongly with the robustness of health infrastructure and antimicrobial governance.

• South-East Asia and the Eastern Mediterranean: These regions report the highest resistance, with one in three infections showing resistance. K. pneumoniae carbapenem resistance has reached 41.2% in parts of Southeast Asia.
• Africa: One in five infections is resistant; third-generation cephalosporin resistance in E. coli and K. pneumoniae exceeds 70%.
• Europe: Shows the lowest levels, with approximately one in ten infections resistant.
• Low- and Middle-Income Countries (LMICs): Bear a disproportionate burden due to factors such as limited diagnostic access, overuse of broad-spectrum antibiotics (which accounted for 45.3% of global antibiotic consumption in 2022), and weak surveillance networks.

An inverse relationship is evident between AMR prevalence and the Universal Health Coverage (UHC) index. Countries with lower UHC scores tend to exhibit higher AMR rates, reflecting the interconnected nature of healthcare accessibility, infection control, and antibiotic regulation.
Surveillance quality is currently strongest in South-East Asia (61.2% completeness), while the Americas and Europe lag behind at 46.7%. Nevertheless, data biases persist due to an overrepresentation of samples from urban tertiary hospitals.

Strategic Recommendations and Policy Priorities

In alignment with the 2024 United Nations General Assembly declaration on AMR, the WHO report reiterates the necessity of a One Health approach, integrating human, animal, and environmental health perspectives.
Key recommendations include:

• Enhanced surveillance and reporting: All nations should aim to provide comprehensive, high-quality AMR and antimicrobial usage data to GLASS by 2030, ensuring at least 80% diagnostic capacity for priority pathogens.
• Laboratory strengthening and data linkage: Investment in laboratory infrastructure and the integration of microbiological data with epidemiological factors to enable targeted interventions.
• Antimicrobial stewardship: Implementation of evidence-based prescribing protocols, coupled with infection prevention strategies such as vaccination, sanitation, and hygiene improvements.
• Research and development: Accelerated innovation in new antibiotics, especially those targeting high-impact resistant pathogens, alongside global mechanisms for equitable access to effective treatments.
• Reduction in antibiotic misuse: Curtailing non-prescription use and improving diagnostic capacity to reduce inappropriate antimicrobial exposure.
• Mortality reduction target: Achieve a 10% decrease in AMR-related deaths by 2030, relative to 2019 baseline figures (4.95 million deaths).
• Interdisciplinary collaboration: Support for global research partnerships focused on novel therapies, diagnostic technologies, and data-sharing systems.

Broader Implications

The 2025 WHO report underscores that AMR is no longer a distant threat but an active and escalating crisis affecting every region of the world. Without coordinated intervention, many common bacterial infections could become untreatable, reversing decades of medical progress. The findings reaffirm the urgent need for international cooperation, sustained funding, and responsible antimicrobial stewardship to preserve the effectiveness of existing antibiotics and safeguard global health security for future generations.