Analysis of international surveillance data shows rising resistance to last-line antibiotics, with significant regional variations in treatment outcomes.
A new analysis of global antimicrobial resistance surveillance data reveals alarming trends in bacterial and fungal resistance patterns, with some regions reporting resistance levels exceeding 70% for key pathogens while others maintain single-digit rates.
The study, published in the Medical Journal of Peking Union Medical College Hospital, examined data from international surveillance programs, including CARS, SENTRY, and One Health Trust–ResistanceMap, to chart the spread of resistant microorganisms and identify molecular mechanisms driving treatment failures.
Researchers from Jilin University and Peking Union Medical College Hospital found that Escherichia coli and Klebsiella pneumoniae remain the most prevalent resistant pathogens globally, with β-lactamase-producing strains widespread across Asia and carbapenem-resistant variants increasing throughout Europe and the Americas.
The analysis identified particularly concerning resistance patterns in Acinetobacter baumannii and Pseudomonas aeruginosa, which showed resistance levels above 70% in some regions compared to single-digit rates in northern Europe.
Fungal Resistance Emerges as Growing Concern
The study also documented the emergence of Candida auris as a near-pan-resistant pathogen, while Aspergillus fumigatus is developing azole resistance, partly attributed to agricultural fungicide use. These findings highlight the interconnected nature of resistance development across human medicine and agriculture.
“[Antimicrobial resistance] represents a slow-moving pandemic,” says Dr Xuesong Xu, lead author of the study, in a release. “Our review shows that resistance patterns are constantly shifting, shaped by human behavior, healthcare systems, and environmental factors. No country can fight this battle alone.”
The researchers identified several genetic pathways underlying these resistance threats, including β-lactamase expansion, carbapenemase evolution, and efflux pump overexpression. These mechanisms allow pathogens to neutralize multiple classes of antimicrobial drugs.
Regional Disparities Reflect Policy Differences
The analysis revealed sharp differences between countries, driven by distinct drug policies and healthcare systems. Developing regions with weak surveillance systems and over-the-counter antibiotic availability showed higher resistance rates compared to areas with established stewardship programs.
The study authors recommend individualized treatment approaches guided by pharmacokinetic and pharmacodynamic data, including the use of β-lactamase inhibitors, tigecycline, and polymyxin-based combinations.
Beyond clinical interventions, the researchers call for coordinated international surveillance, tighter prescription controls, and responsible antibiotic use in agriculture. They emphasize the need for hospitals to embrace genomic diagnostics and AI-assisted decision systems for real-time therapy optimization.
“What’s needed is a unified One Health strategy that bridges medicine, agriculture, and ecology,” says Xu in a release. “Only by strengthening surveillance, optimizing antibiotic use, and fostering innovation can we prevent a future where routine infections once again become deadly.”
The findings underscore the need for continued investment in next-generation antimicrobials, β-lactamase inhibitors, and diagnostic technologies capable of detecting resistance mechanisms before they compromise treatment outcomes.
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