How Bacterial Resistance is Reshaping Hospital Medicine
Pathogen-antibiotic combinations with rising resistance 1
Imagine checking into a hospital for a routine procedure, only to develop an infection that defies every antibiotic the doctors try. This scenario is becoming increasingly common in healthcare facilities worldwide. In 2023, a startling one in six laboratory-confirmed bacterial infections in hospitals were resistant to antibiotic treatments, according to a comprehensive World Health Organization report that analyzed over 23 million bacterial infections from 104 countries 1 3 .
Between 2018 and 2023, antibiotic resistance rose in over 40% of the pathogen-antibiotic combinations that doctors routinely rely on, with an average annual increase of 5-15% 1 .
This isn't the plot of a science fiction movie—it's the reality facing modern medicine as we navigate the complex challenge of antimicrobial resistance (AMR) in hospital settings.
Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites evolve over time and no longer respond to the medicines designed to kill them. This natural evolutionary process is accelerated by the overuse and misuse of antimicrobials, creating superbugs that can cause treatments to fail, spread infections, and increase the risk of severe illness and death 7 .
The numbers behind this crisis are sobering. In 2021 alone, bacterial infections caused an estimated 7.7 million deaths globally. Drug resistance contributed to 4.71 million of these deaths, with 1.14 million directly attributed to AMR 3 6 . The WHO describes AMR as "outpacing advances in modern medicine, threatening the health of families worldwide" 1 .
"These bacteria don't respect borders, and problems emerging in one part of the world have implications for us all. This is one reason that global coordination is essential to tackle AMR."
What makes this battle particularly challenging is that it's not fought on a single front. Resistance patterns vary dramatically across regions, creating a patchwork of microbial threats that require localized strategies. The problem is most severe in the WHO South-East Asian and Eastern Mediterranean Regions, where one in three reported infections were resistant to standard antibiotics. In the African Region, the figure stands at one in five infections 1 . These disparities reflect differences in healthcare infrastructure, antibiotic regulation, and access to quality care.
Within the microscopic world of pathogens, gram-negative bacteria have emerged as particularly formidable adversaries in hospital settings. These bacteria are characterized by an additional outer membrane that protects them from many antibiotics, making them naturally harder to treat 3 .
| WHO Region | Resistance in E. coli | Resistance in K. pneumoniae | Overall Resistance Rate |
|---|---|---|---|
| African Region | >70% | >70% | 1 in 5 infections |
| South-East Asia | Not specified | Not specified | 1 in 3 infections |
| Eastern Mediterranean | Not specified | Not specified | 1 in 3 infections |
| Europe | Not specified | Not specified | 1 in 10 infections |
Other troublesome gram-negative bacteria include Acinetobacter, which shows alarming resistance to carbapenems (54.3% of bloodstream infections globally), and Salmonella species 1 8 . This escalation is particularly concerning because carbapenems are classified as "Watch" antibiotics by the WHO—broad-spectrum agents reserved for more severe infections when other treatments have failed 8 .
In 2015, the World Health Organization established the Global Antimicrobial Resistance and Use Surveillance System (GLASS) to coordinate worldwide tracking of this emerging threat. The 2025 report represents the most comprehensive assessment of AMR to date, drawing on data from 104 countries representing 70% of the world's population 2 8 .
The surveillance focuses on eight common bacterial pathogens linked to infections of the urinary tract, gastrointestinal tract, bloodstream, and urogenital gonorrhoea 1 . The system collects laboratory-confirmed cases and tests their susceptibility to 22 different antibiotics, creating a detailed map of resistance patterns across geography and time 1 2 .
The GLASS data reveal clear patterns in how resistance varies by infection type. Median antibiotic resistance was most common in urinary tract infections (1 in 3) and bloodstream infections (1 in 6), and less frequent in gastrointestinal (1 in 15) and urogenital gonorrheal infections (1 in 125) 8 .
| Pathogen | Antibiotic Class | Resistance Trend | Clinical Implications |
|---|---|---|---|
| E. coli | Third-generation cephalosporins | >40% resistance globally | First-line treatments failing |
| K. pneumoniae | Third-generation cephalosporins | >55% resistance globally | Limited options for severe infections |
| Acinetobacter | Carbapenems | 54.3% resistance in bloodstream infections | Approaching pan-resistance |
| K. pneumoniae | Carbapenems | Rising dramatically (41.2% in SE Asia) | Last-resort options dwindling |
The report also tracks resistance trends over time, providing crucial insights into how the threat is evolving. Between 2018 and 2023, resistance to essential second-choice antibiotics, particularly carbapenems and fluoroquinolones, increased among key gram-negative bacteria including Acinetobacter, K. pneumoniae, and Salmonella 3 .
"These antibiotics are critical for treating severe infections and their growing ineffectiveness is narrowing the treatment options."
Understanding and combating antimicrobial resistance requires specialized tools and approaches. Researchers in this field rely on a diverse set of resources to track, analyze, and combat resistant infections:
These tools allow scientists to decode the DNA of bacteria and identify specific resistance genes 6 .
Coordinated interventions designed to optimize antibiotic use in healthcare settings 4 .
Practices like hand hygiene and environmental cleaning that prevent the spread of resistant bacteria 6 .
"Sequencing the genomes of these microbes lets us peak underneath these headline resistance rates, and shows us that while each country has their own unique set of bacterial strains and genes that cause resistant infections, there are also some globe-trotting strains that have disseminated across continents."
Confronting the complex challenge of antimicrobial resistance requires a multifaceted approach that spans from laboratory benches to hospital bedsides, and from local communities to global policy forums.
The fourfold increase in country participation in GLASS since 2016 (from 25 to 104 countries) represents significant progress, but gaps remain 1 . The WHO calls on all countries to report high-quality data on AMR and antimicrobial use to GLASS by 2030.
Optimizing antibiotic use in hospitals requires empowering healthcare professionals with knowledge and tools. Educational opportunities for nurses should include role of AMS in preventing antimicrobial resistance, infection prevention, and diagnostics 4 .
The antibiotic pipeline, particularly for gram-negative bacteria, remains alarmingly empty. Professor José Bengoechea notes: "Currently, there are no compounds in late-stage development for treatment of resistant Klebsiella infections" 6 .
Ultimately, tackling AMR requires going beyond the healthcare sector to address root causes. This might include improving access to safe housing and water, extending health coverage, and addressing economic inequities 7 .
Particularly explored for vulnerable newborns in low-resource settings 6 .
Could prevent 80,000 newborn deaths and over 100,000 antibiotic doses annually 6 .
Renewed investment needed for interdisciplinary research against drug-resistant bacteria 3 .
The rise of antimicrobial resistance in hospitals represents one of the most significant challenges to modern medicine. As Dr. Manica Balasegaram from the Global Antibiotic Research and Development Partnership starkly warns, "The most difficult-to-treat gram-negative infections are now beginning to outpace antibiotic development" 3 . The consequence of this mismatch is expected to be a 70% increase in AMR-related deaths by 2050 3 .
The battle against antimicrobial resistance in hospitals is not just a medical or scientific challenge—it's a test of our collective ability to respond to a complex global health threat that respects no borders. The choices we make today—in how we use antibiotics, how we prevent infections, and how we prioritize research—will determine whether we can preserve these miracle drugs for future generations.