The World Health Organization (WHO) released its Global Antibiotic Resistance Surveillance Report 2025, providing the most comprehensive analysis to date of antimicrobial resistance (AMR) worldwide. Based on data from the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS), the report covers over 23 million bacteriologically confirmed infections reported by 104 countries between 2016 and 2023. It presents adjusted estimates of resistance for 93 infection type–pathogen–antibiotic combinations, spanning bloodstream, gastrointestinal, urinary tract, and urogenital gonorrhoea infections.
This report marks a significant advancement from previous editions by using Bayesian statistical modelling to account for national differences in surveillance coverage, population structure, and demographic factors, offering more reliable national, regional, and global estimates of AMR prevalence and trends.
Key Global Findings
1. Surveillance Participation Has Grown, but Gaps Persist
- Since 2016, country participation in GLASS has increased four-fold, with 104 countries reporting data in 2023 compared to 25 in 2016.
- However, participation remains uneven:
- Highest in South-East Asia (90.9%) and Eastern Mediterranean (76.2%).
- Lowest in the Americas (20.0%) and Western Pacific (37.0%).
- Only 46.2% of reporting countries had all WHO-recommended core components of a national AMR surveillance system in place.
2. Global Resistance Levels Are High and Uneven
- In 2023, approximately one in six laboratory-confirmed bacterial infections worldwide was caused by antibiotic-resistant bacteria.
- Resistance was most common in urinary tract infections (~1 in 3) and bloodstream infections (1 in 6).
- Regional disparities are stark:
- Highest median resistance in South-East Asia and Eastern Mediterranean regions (~1 in 3 infections).
- Lowest in the European Region (1 in 10) and Western Pacific Region (1 in 11).
3. Gram-Negative Pathogens Show Increasing Resistance Trends
- Between 2018 and 2023, AMR increased in 40% of pathogen–antibiotic combinations monitored.
- Key concerns include rising resistance to carbapenems and fluoroquinolones among Gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae, Acinetobacter spp., and Salmonella spp.
- For example, global resistance to imipenem in K. pneumoniae bloodstream infections increased by 15.3% per year.
4. Countries with Lower Surveillance Coverage Report Higher Resistance
- A strong inverse correlation exists between national AMR surveillance coverage and reported median resistance (Pearson r=−0.74, P<0.0001).
- In low-coverage settings, data often come from tertiary hospitals with more severe cases, leading to potential overestimation but also reflecting true higher burdens in under-resourced health systems.
5. AMR Disproportionately Affects Low- and Middle-Income Countries (LMICs)
- There is a strong inverse correlation between Universal Health Coverage (UHC) service coverage index, national income level, and AMR prevalence.
- LMICs with weaker health systems, limited diagnostics, and restricted access to effective antibiotics face a syndemic of undertreatment and poor outcomes.
Focus on the Eastern Mediterranean Region
The report highlights the Eastern Mediterranean Region (EMR) as one of the most severely affected by AMR.
Key Statistics for EMR (2023):
- Nearly 1 in 3 infections were resistant to antibiotics — the highest regional proportion alongside South-East Asia.
- 56.9% of Shigella spp. gastrointestinal infections were resistant to ceftriaxone, a critical third-generation cephalosporin.
- 50.3% of bloodstream Staphylococcus aureus infections were methicillin-resistant (MRSA), limiting treatment options and escalating costs.
- 66.5% of Acinetobacter spp. bloodstream infections were resistant to imipenem, a broad-spectrum carbapenem.
- Resistance to imipenem in Acinetobacter spp. increased by 11.3% annually between 2016 and 2023.
Clinical and Public Health Implications in EMR:
- High resistance to ceftriaxone in Shigella complicates management of severe diarrhoeal diseases, especially in children.
- MRSA prevalence necessitates greater use of alternative, often costly, antibiotics such as vancomycin or newer reserve agents.
- Rising carbapenem resistance in Acinetobacter and K. pneumoniae threatens last-line treatment options, increasing mortality risks in hospital-acquired infections.
Resistance by Infection Type
Bloodstream Infections
- E. coli and K. pneumoniae resistant to fluoroquinolones and third-generation cephalosporins were the most frequently reported drug-resistant bloodstream pathogens globally in 2023.
- In the African Region, K. pneumoniae resistant to third-generation cephalosporins was the most common.
- MRSA remains a significant concern, with the highest prevalence in the Eastern Mediterranean Region.
Gastrointestinal Infections
- Shigella spp. showed high resistance to ciprofloxacin (75.5% in South-East Asia) and azithromycin.
- Salmonella spp. resistance to ciprofloxacin is rising, notably in the European Region.
Urinary Tract Infections
- E. coli and K. pneumoniae exhibited high resistance to co-trimoxazole, third-generation cephalosporins, and fluoroquinolones.
- Carbapenem resistance in K. pneumoniae is notable, especially in South-East Asia.
Urogenital Gonorrhoea
- Ciprofloxacin resistance in Neisseria gonorrhoeae is nearly universal (75.0% globally).
- Although ceftriaxone resistance remains low globally (0.3%), emergence in regions like Eastern Mediterranean (2.5%) threatens the last effective empirical treatment.
Methodological Advances
The 2025 report introduces enhanced statistical methods:
- Bayesian hierarchical models adjust for surveillance coverage biases.
- Age- and sex-standardized estimates improve comparability across countries.
- A scoring framework evaluates data completeness across four domains: national system implementation, surveillance coverage, infection-type data availability, and epidemiological detail.
A systematic review of literature (2019–2024) complements GLASS data, often showing higher resistance estimates—likely reflecting tertiary hospital bias—but filling geographical gaps where surveillance is limited.
Priorities for Action
WHO outlines five priority actions based on the report’s findings:
- Increase participation in GLASS, especially in underrepresented regions.
- Implement integrated intervention packages (infection prevention, water/sanitation, vaccination, stewardship).
- Reduce use of Watch-group antibiotics and increase Access-group antibiotics to ≥70% by 2030.
- Strengthen national AMR surveillance capacity and diagnostic access.
- Address AMR through health system strengthening and equitable access to care, particularly in LMICs.
Conclusion
The WHO GLASS Report 2025 underscores that antimicrobial resistance remains a critical and growing global health threat, with severe inequalities across regions. The Eastern Mediterranean Region exemplifies the crisis, with alarmingly high resistance rates across key pathogens and antibiotics. Urgent, coordinated action—guided by robust surveillance and equity-focused policies—is essential to curb the spread of AMR, preserve antibiotic efficacy, and protect global health security.
