ANTIMICROBIAL resistance is rising unevenly worldwide, with healthcare setting, geography, and antibiotic exposure driving risk.
Antimicrobial Resistance Varies by Region
A narrative review of global evidence from 2015–2025 highlights substantial variation in antimicrobial resistance and antimicrobial use across regions, healthcare levels, and patient populations. The findings reinforce antimicrobial resistance as a major public health threat, particularly in low and middle income countries, where diagnostic capacity, regulatory enforcement, and surveillance infrastructure are often limited.
The review found that antimicrobial consumption has increased in several WHO regions, including Southeast Asia, Africa, the Americas, and the Eastern Mediterranean, while decreasing trends were reported in many countries in Europe and the Western Pacific. These differences reflect not only prescribing behavior, but also infectious disease burden, access to diagnostics, and the frequency of empirical antibiotic use.
Carbapenem Resistance Signals Escalating Risk
Carbapenem resistance emerged as a key marker of treatment limiting antimicrobial resistance. Global monitoring data showed carbapenem resistance in Escherichia coli remained relatively low at 2.4%, yet this figure concealed marked local variation, including 17.5% in Southeast Asia and approximately 40% in India.
Resistance was more consistently elevated in Klebsiella pneumoniae, reaching 41.2% globally and 54% in India. Pseudomonas aeruginosa carbapenem resistance remained relatively stable, at approximately 36% globally and in India, although Southeast Asian rates reached 45%. These findings suggest that global averages may underestimate the clinical challenge faced in high burden regions and tertiary care settings.
Antimicrobial Stewardship Needs Targeted Data
Resistance prevalence increased from primary to tertiary care, reflecting greater antimicrobial exposure and higher concentrations of complex, vulnerable patients. Pediatric, elderly, pregnant, and immunocompromised patients were identified as groups at greater risk of antimicrobial exposure and related harms, including nephrotoxicity, hepatotoxicity, and microbiome disruption.
The review also reported a global shift toward increased use of Watch category antibiotics under the WHO AWaRe framework, underscoring the need for stronger antimicrobial stewardship. Effective strategies included audit and feedback, prescribing restrictions, rapid diagnostics, and clinical decision support systems.
Integrated surveillance, data driven antimicrobial stewardship, and a One Health approach are essential to address antimicrobial resistance across human healthcare, animal health, and environmental sectors. The findings point to a need for region specific policies that reflect local resistance patterns, prescribing pressures, and healthcare infrastructure.
Reference
Raut N et al. Antimicrobial Consumption and Resistance Dynamics Across Healthcare Level: Global Evidence and Stewardship Implications. Pathogens. 2026;15(4):414.
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