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Review
. 2025 May 5;6(2):21.
doi: 10.3390/epidemiologia6020021.

The Global Burden of Multidrug-Resistant Bacteria

Andrea Marino  1 , Antonino Maniaci  2 , Mario Lentini  2 , Salvatore Ronsivalle  2 , Giuseppe Nunnari  1 , Salvatore Cocuzza  3 , Federica Maria Parisi  3 , Bruno Cacopardo  1 , Salvatore Lavalle  2 , Luigi La Via  4
Affiliations
Review

The Global Burden of Multidrug-Resistant Bacteria

Andrea Marino et al. Epidemiologia (Basel). .

Abstract

Background/Objectives: This narrative review provided a broad synthesis of recent epidemiological trends, priority resistance mechanisms, and public health implications of multidrug-resistant (MDR) bacteria. We focused on the most clinically significant MDR pathogens, regional differences in resistance, and the effectiveness of containment strategies. Our goal was to synthesize current knowledge and propose research directions. Methods: Through comprehensive analysis of epidemiological studies, surveillance reports, clinical trials, and meta-analyses, we present a detailed assessment of the evolving landscape of antimicrobial resistance across both developed and developing nations. The review encompasses data from 187 countries, analyzing over 2500 published studies and reports from major health organizations. Results: Our findings reveal a concerning 43% increase in multidrug-resistant infections globally, with particularly sharp rises in healthcare-associated infections (67% increase) and community-acquired infections (38% increase) in regions with high antibiotic misuse. The analysis specifically focuses on critical pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE), documenting their prevalence, transmission patterns, and treatment outcomes. Economic impact assessments indicate annual global healthcare costs exceeding USD 100 billion due to resistant infections. The review identifies significant gaps in current surveillance systems, particularly in low- and middle-income countries, and proposes standardized approaches for monitoring and containment strategies. We evaluate the effectiveness of various antimicrobial stewardship programs, documenting success rates and implementation challenges across different healthcare settings. Conclusions: The analysis concludes with evidence-based recommendations for policy reforms, research priorities, and international collaboration frameworks necessary to address this growing global health crisis. Our findings highlighted the importance of strengthening stewardship efforts, proposing novel diagnostics and therapeutic interventions, and addressing inequities in access to care and data across different countries.

Keywords: antimicrobial resistance; global health; global surveillance; healthcare costs; multidrug-resistant bacteria; surveillance systems.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Diagram of key resistant pathogens. Abbreviations: MRSA—methicillin-resistant Staphylococcus aureus; VRE—vancomycin-resistant Enterococcus; CRE—carbapenem-resistant Enterobacteriaceae; ESBL—extended-spectrum β-lactamase; OMP—outer membrane protein; WHO—World Health Organization; CDC—Centers for Disease Control and Prevention; ECDC—European Centre for Disease Prevention and Control; P. aeruginosa—Pseudomonas aeruginosa; A. baumannii—Acinetobacter baumannii; S. pneumoniae—Streptococcus pneumoniae; N. gonorrhoeae—Neisseria gonorrhoeae.
Figure 2
Figure 2
Overview of major antimicrobial resistance mechanisms and associated pathogens.
Figure 3
Figure 3
Global surveillance actions to prevent multidrug resistance.
See this image and copyright information in PMC

References

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