Emerging Trends in Antimicrobial Resistance: A Global Review of Surveillance, Challenges, and Strategies

Riaz Ahmed
Department of Medical Sciences, Military College of Signals NUST, Islamabad, Pakistan
Correspondence to: Riaz Ahmed, riazkhattak450@gmail.com

DOI: https://doi.org/10.70389/PJPH.100023

Additional information

• Ethical approval: N/a
• Consent: N/a
• Funding: No industry funding
• Conflicts of interest: N/a
• Author contribution: Riaz Ahmed – Conceptualization, Writing – original draft, review and editing
• Guarantor: Riaz Ahmed
• Provenance and peer-review:
  Unsolicited and externally peer-reviewed
• Data availability statement: N/a

Keywords: Antimicrobial resistance, Surveillance systems, Low- and middle-income countries, Resistance drivers, One health approach.

Peer Review
Received: 28 May 2025
Revised: 14 July 2025
Accepted: 14 July 2025
Published: 26 July 2025

Plain Language Summary Infographic

Introduction

Background and Historical Emergence of Antimicrobial Resistance (AMR)

AMR refers to the capability of microorganisms like viruses, bacteria, fungi, and parasites to resist the medications that were able to treat them effectively.^1,2 Antibiotics in the twentieth century emerged as a revolutionary modern medicine that significantly reduced the mortality rate. However, the resistance emerged after the 1940s (penicillin-resistant Staphylococcus aureus), and it is evolving into a widespread and complicated crisis.³ The phenomenon of AMR renders standard treatments ineffective, letting infections spread and persist and increasing the risk of severe illness leading to death. AMR occurs naturally, but the progression of the process has increased dramatically because of human actions, specifically due to antimicrobial misuse in agriculture, health care, and the environment.^4,5 The global health community has indicated AMR as the most pressing public health threat of the twenty-first century, as 10 million deaths are forecasted by 2050 due to AMR.⁶ Therefore, the global usage and consumption of antibiotics are closely monitored all the time. The outcomes of the failure to properly address AMR are deeply affecting, as estimates show the return of the preantibiotic era that was associated with everyday infections related to childbirth, open fractures, limbs, and surgery that can be potentially life-threatening again (Figure 1).⁷

Scope of Research

The current study follows a secondary research approach for synthesizing and critically analyzing current literature, policy documents, and surveillance reports about AMR. It focuses on finding current epidemiological trends across nonbacterial and bacterial pathogens. It also explores the key resistance drivers across animals, humans, and environmental domains. The paper also includes global and regional strategies like stewardship programs, One Health initiatives, and national action plans (NAPs) created to reduce AMR. The global nature of the current review highlights the regional disparities among high-income countries and low- and middle-income countries (LMICs). The data collected for the review is from 2020 to 2025.

Research Aim and Objectives

The purpose of the current review is to provide an inclusive analysis of current and global trends in AMR, the efficiency and limitations of surveillance frameworks, and environmental and socioeconomic resistance drivers. The research objectives are:

1. To critically examine current global trends in AMR and their epidemiological implications across agriculture, health care, and the environment
2. To estimate and compare international AMR surveillance frameworks and AMR spread, including their strengths and weaknesses
3. To evaluate global and regional strategies aimed at mitigating AMR, including stewardship programs, policy frameworks, and public health interventions
4. To identify critical research gaps and propose recommendations for improving surveillance, intersectoral coordination, and global response capacity

Methodology

This review is based on the structured literature review approach, providing the necessary care by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Wide searches were done in various databases such as PubMed, Scopus, Web of Science, and WHO AMR databases with articles published between 2020 and 2025.

Search Strategy: Keywords such as “antimicrobial resistance,” “AMR surveillance,” “drug-resistant infections,” “global health,” and “One Health” were used in combination with Boolean operators (AND, OR) to capture relevant studies.

Inclusion Criteria:

• The peer-reviewed articles, surveillance reports, and policy documents released in 2020–2025
• Research involving a human, animal, or environmental AMR
• Publications in English: English-language publications

Exclusion Criteria:

• Studies of insufficient data or insufficient technique
• Non-peer-reviewed commentaries or editorials

Selection Process: A total of 136 records had been screened (title and abstract) after eliminating redundancy. Among the 76 articles that were screened in full-text, 42 were identified to fulfill the inclusion criteria and were included during the final review. The PRISMA flow diagram (Figure 2) is a graphical display of how many studies were identified, screened, and excluded in the process of selecting studies in a systematic review, and how many finally made the grade. It is transparent and allows the readers to come across how the number of final studies (here, 42) was arrived at.

Global Epidemiology and Trends of AMR

Current Trends in Resistant Bacterial Pathogens: Bacterial resistance is intensified globally due to various pathogens emerging as critical threats.2 Currently, common infections like urinary tract infections, tuberculosis, and sepsis are also becoming harder, and, in a few cases, they have become impossible to treat because of the increasing resistance.6 Methicillin-resistant S. aureus is prevalent in both community settings and hospitals, and it causes severe bloodstream and skin infections.⁹ Furthermore, carbapenem-resistant Enterobacterales (CRE) are specifically of concern because of limited options for treatment.¹⁰ Extensively drug-resistant tuberculosis (XDR-TB) has been reported in most countries, complicating TB control efforts. Multidrug-resistant Salmonella strains are rising, particularly in regions with high antibiotic use in livestock. Neisseria gonorrhoeae is showing resistance to multiple drugs, including ceftriaxone, raising fears of untreatable gonorrhea. These trends highlight an urgent need for coordinated interventions.

AMR in Nonbacterial Pathogens: AMR is also increasing in viruses, fungi, and parasites. Drug-resistant HIV strains are emerging, particularly where antiretroviral therapy adherence is inconsistent.¹¹ Candida auris, a multidrug-resistant fungal pathogen, is causing invasive infections with high mortality rates, especially in intensive care units. Resistance to front-line antifungal drugs such as fluconazole and echinocandins has been documented globally. In parasitology, resistance in Plasmodium falciparum, the malaria-causing parasite, is threatening control efforts, especially in Southeast Asia and parts of Africa, where artemisinin resistance has been observed. These trends in nonbacterial AMR demonstrate the importance of broad-spectrum global surveillance and response.

Regional and Income-Based Variations in AMR Patterns: AMR also presents a microcosm of factors like civil unrest, ethnic displacement, social anthropology, health care, political systems, and societal and economic behaviors at individual and population levels.¹² Significant regional disparities exist in AMR patterns, largely influenced by health care infrastructure, antibiotic usage practices, and surveillance capacities.¹³ High-income countries (HICs) tend to have stronger regulatory systems and better infection control, allowing earlier detection and management of AMR. In contrast, LMICs often lack resources for appropriate diagnostics and enforcement of prescription guidelines, contributing to higher rates of resistance.¹⁴

AMR Surveillance Systems: Current Approaches and Gaps

Overview of Major Surveillance Frameworks

The European Centre for Disease Prevention and Control (ECDC), WHO’s Global Antimicrobial Resistance and Use Surveillance System (GLASS), and the US Centers for Disease Control and Prevention (CDC) as a surveillance system are offering critical perceptions about AMR trends. GLASS is reporting on increasing resistance of E. coli, S. aureus, and Klebsiella pneumoniae, particularly in bloodstream infections.¹⁵ However, CDC data revealed a significant resistance to colistin and carbapenem in Europe, specifically in K. pneumoniae.¹⁶ The updates of the CDC (2022) have highlighted the persistent threats from N. gonorrhoeae, CRE, and C. auris.^17,18 NARMS is another framework in the US tracking AMR in foodborne pathogens, and EARS-Net monitors resistance trends in Europe.^19,20 Furthermore, AGISAR supports integrated surveillance in the food chain, and ReLAVRA targets AMR in Latin America.²¹ These frameworks provide valuable data but vary in coverage, frequency, and coordination, limiting their ability to provide a complete picture of global AMR threats (Figure 3).

Strengths and Weaknesses of Current Systems

Surveillance systems offer structured platforms for collecting, analyzing, and disseminating AMR data, enabling policymakers and researchers to track resistance patterns and inform interventions. Strengths include international collaboration, standardized methodologies (as in GLASS), and long-term data trends.¹⁵ However, weaknesses persist as many systems lack real-time reporting, face underreporting from LMICs, and have limited coverage in the veterinary and environmental sectors.²¹

Role of Technological Tools

Advanced technologies are transforming AMR surveillance, like next-generation sequencing, which enables precise identification of resistance genes and outbreak tracking.²³ Artificial intelligence (AI) and machine learning algorithms can detect patterns and predict resistance trends using large datasets.²⁴ Bioinformatics tools allow researchers to analyze genomic data, enhancing the early detection of novel resistance mechanisms.²⁵ Mobile health (mHealth) platforms help collect and transmit data from remote or under-resourced areas in real-time.²⁶

Data Collection Barriers in LMICs

LMICs are facing challenges in the surveillance of AMR due to the barriers of limited laboratory infrastructure, inconsistent supplies of diagnostic tools, and a trained personnel shortage.²⁷ Various facilities lack standards and protocols for testing or electronic health records for data sharing and storage. Additionally, financial constraints and a lack of national coordination impact global networks like GLASS.²⁸ These barriers highlight significant data gaps and delay the timely detection of emerging patterns of resistance within vulnerable regions.

Integration Issues Between Human, Animal, and Environmental Health Data

A One Health approach, integrating human, animal, and environmental data, is required for effective surveillance of AMR.²⁹ Still, the effective operations of advanced systems limit the cross-sectional analysis. For example, veterinary AMR data can be managed separately from human health data, following different standards and time frames.³⁰ Furthermore, environmental resistance causes, like wastes from pharmaceuticals, are not systemically monitored. Weak coordination among various ministries, including agriculture, health, and the environment, also creates issues for integration.³¹

Drivers of AMR: Clinical, Agricultural, and Environmental

Misuse and Overprescription of Antibiotics in Human Medicine

The misuse and overprescription of antibiotics in clinical settings is one of the primary drivers of AMR.^5,25 For example, physicians can prescribe unnecessary antibiotics because of patient pressure, diagnostic uncertainty, and lack of comprehensive assessments. Furthermore, antibiotics are also distributed in various world regions without prescription, leading to incomplete treatment courses and self-medication. It further promotes resistant strains. Another aspect is access to rapid diagnostic tests that result in the usage of broader-spectrum antibiotics.³² Deaths increase due to inappropriate medication practices that cause drug-resistant infections, as identified in the Statista (2023) report (Figure 4).

Use of Antimicrobials in Livestock, Aquaculture, and Crop Protection

Increased antimicrobial usage in agriculture and husbandry is contributing to AMR.34 These antibiotics are not only used for treating infections in livestock production but also to promote growth and as preventive measures in farms with dense populations.³⁴ In aquaculture, antibiotics are mixed in feed or added to water to reduce disease risks. Tetracycline and streptomycin are used in sprays in crop farming to control bacterial infection risks within vegetables and fruits.³⁵

Poor Infection Control and Sanitation Infrastructure

Poor sanitation and inadequate infection prevention are essential and unnoticed factors that increase AMR.¹² Lacking standard hygienic practices in health care facilities, congested hospitals, and limited capacity for isolation increase the spread of resistant pathogens.³¹ Inadequate access to clean water, hygiene, and sanitation facilities enables infectious disease transmission. It also increases the antibiotic demand and the risk of inappropriate use. Environmental dissemination is caused by poor sanitation, which leads to resistant bacteria from fecal waste.³⁶

Pharmaceutical Waste and Environmental Contamination

Environmental pollution from antimicrobial residues and pharmaceutical waste contributes to the emergence and persistence of AMR in ecosystems.³¹ In many manufacturing hubs, especially in countries with weak regulatory enforcement, untreated antibiotic waste is discharged into rivers and soils, creating reservoirs of resistance.¹⁴ Hospitals, households, and agricultural runoff also release antibiotics and resistant microbes into the environment via wastewater systems, which are often inadequate to remove these contaminants.³⁷ These factors are favorable for transferring genes among bacteria in the soil and water bodies, and also increase resistance levels. Environmental AMR control needs strict laws regarding waste disposal, wastewater treatment investment, and infrastructure, and routine monitoring of the environment can help assess the hotspots of AMR.⁴ These points can be managed effectively to minimize resistance.

Socioeconomic Determinants

Socioeconomic aspects also influence the usage of antibiotics, and they intensify AMR.³⁸ Moreover, in various LMICs, individuals having limited access to health care opt for self-medication or prescriptions from informal sources. Further socioeconomic determinants are weak regulatory systems that can increase substandard drugs and counterfeit sales. It further includes pharmaceutical marketing that increases antibiotic use.³¹ Low health literacy, lack of funding for training, and fragmented AMR policies are intensifying AMR in LMICs.

Global and Regional Strategies to Combat AMR

WHO Global Action Plan (GAP) and One Health Approach

WHO launched a GAP in response to increasing AMR in 2015. The purpose of GAP is to focus on the “One Health” approach, integrating human, animal, and environmental health strategies to limit resistance (Figure 5). It was based on five main objectives: improving awareness, minimizing infection incidence, fostering sustainable investment for new drugs, strengthening surveillance, and optimizing antimicrobial use.³⁹ The framework acknowledges ecosystems’ interconnectedness and the requirement of cross-sectional and collaborative efforts (Figure 5).

National AMR Action Plans

NAPs are important to translate the AMR strategies into country-specific policies.³¹ Various nations have adopted NAPs as they are also aligned with WHO’s GAP, involving surveillance systems, regulatory reforms, and stewardship programs. Thailand and the UK have applied measurable progress to reduce antibiotic usage and to improve awareness.³¹ In LMICs, challenges are raised for NAPs regarding limited funding, weak governance, inadequate infrastructure, and insufficient engagement of stakeholders.⁴⁰ It also lacks proper implementation strategies, evaluation, and monitoring mechanisms. Limited antimicrobial consumption data and resistance patterns impact evidence-based decision-making.

Antimicrobial Stewardship Programs (ASPs) in Hospitals and Communities

ASPs are important interventions that are applied to promote responsible antibiotic usage in clinical facilities.⁴¹ ASPs in hospitals include interdisciplinary teams for developing guidelines, monitoring patterns of prescription, and conducting audits for optimizing treatment outcomes to reduce resistance development.^42,43 The program indicated success in minimizing unnecessary prescriptions and increasing patient outcomes within HICs; however, these ASPs in rural and outpatient settings are usually underdeveloped (Figure 6).⁴¹

Incentives for New Drug Development and Public-Private Partnerships

An increasing pathogen resistance has overtaken new antimicrobial drug development, creating a pressing need for innovations in the discovery of antibiotics.⁸ Pharmaceutical companies usually lack financial incentives for investing in antibiotics because of high development costs and limited investment return. Various global initiatives are emerging for incentivizing research and development. Moreover, the Global Antibiotic Research and Development Partnership and CARB-X are public and private partnerships backing early-stage research to minimize the risk of investment in pharmaceutical firms.⁴⁴

Education, Awareness Campaigns, and Behavior Change Communication

Behavior change and public awareness are important to control the misuse of antimicrobials.⁴⁵ Furthermore, misconceptions related to antibiotics for viral infections and the need to complete the prescribed courses without symptoms lead to inappropriate global consumption. WHO’s World Antimicrobial Awareness Week and India’s “Red Line” initiative in India are aimed at raising public awareness about responsible use and awareness regarding AMR risks.^46,47

Comparative Analysis of AMR Trends, Surveillance, and Strategies

Comparison of trends shows that AMR is variable between regions and income levels, and there are important differences in AMR surveillance systems and mitigation strategies.

AMR Pattern in Different Regions: Also, HICs experience less resistance after the practice of controlled use of antibiotics and strict control of infection. In comparison, LMICs report an increased level of resistance, especially in pathogens such as K. pneumoniae, on account of the availability of antibiotics over the counter and a shortage of diagnostics.

Surveillance Systems: GLASS, ECDC, and CDC come with powerful data infrastructures in HICs wherein the updates are in real-time, and the integration with the genome is present. By contrast, reporting surveillance in the LMICs is subject to fragmentation, lack of infrastructure, and underreporting, and lacks comparability to aid in early identification of resistance hotspots.

Policy and Strategy Implementation: HICs have adopted holistic stewardship programs and NAPs that are target-driven. To give an example, the Swedish Strategic Programme Against Antibiotic Resistance (STRAMA) program has been an effective instrument in reducing the use of antibiotics. On the contrary, LMICs have financial, logistical, and governance complications that hinder the effective implementation of their action plans.

One Health Integration: Whereas worldwide policies support One Health, limited countries completely combine data from human, animal, and environmental health. Compared to LMICs, HICs are more advanced in cross-sectoral alliances, and LMICs regularly experience data and institutional silos.

Case Studies and Best Practices

Sweden’s Success in Antibiotic Stewardship: Sweden is globally recognized for an effective ASP, which is the Swedish STRAMA.⁴⁸ The initiative is applied through coordinated policies for the promotion of rational prescriptions, infection prevention, and surveillance. Under this program, the clinicians are receiving regular training and usage of antibiotics that are also closely monitored. The results show that Sweden reports the lowest consumption rates of antibiotics and resistance levels.⁴⁸ The success of the program shows the importance of earlier government engagement, sustained investment, and public trust in health care education and collaboration.

India’s “Red Line” Campaign: The Red Line campaign was launched by India to increase public awareness regarding the effective use of antibiotics.⁴⁷ The antibiotics that needed a prescription were marked by the red line on the packaging, and the aim of the campaign was to discourage self-medication and counterfeits. The campaign followed TV, community health workers, and print media to explain AMR risks. The public’s awareness was successfully increased, but challenges related to enforcement persisted with this innovative and low-cost model.

Lessons Learned from COVID-19: The COVID-19 pandemic underscored both the challenges and opportunities for global AMR coordination.⁷ Although the crisis diverted attention and increased antibiotic use, it also strengthened laboratory networks, surveillance capacity, and international cooperation. Rapid data sharing, real-time diagnostics, and cross-border public health responses during COVID-19 offer valuable lessons for AMR preparedness. The pandemic emphasized the need for resilient health systems and the integration of AMR into global health security agendas, encouraging momentum for renewed investment in coordinated, multisectoral AMR strategies.⁷

Future Directions and Research Priorities

As AMR continues to escalate globally, future efforts must prioritize long-term, integrated strategies. A unified global governance structure is critical to coordinate AMR responses, as fragmented national efforts hinder progress. Strengthening institutions like the WHO with broader mandates and sustainable funding mechanisms such as pooled international funds and public-private partnerships can enhance global coordination, especially in LMICs. Real-time data analytics and genomic technologies are also changing AMR surveillance. Furthermore, whole-genome sequencing helps with the quick assessment of the resistance genes and tracks outbreaks.⁴⁹ The integration of AI tools and big data can also predict the trends of resistance, and these can also guide interventions. AMR also needs to include preparedness plans, as COVID-19 identified the fragile nature of the health care system and the unregulated usage of antibiotics that can intensify resistance.

Conclusion

The alarming upsurge in the AMR across bacterial and nonbacterial pathogens in different patterns impacted by income level, region, and sectoral practices is assessed in the current study. However, international surveillance frameworks, including NARMS, GLASS, CDC, ECDC, and EARS-Net, are providing information about vulnerable data to assess significant gaps in the LMICs. The AMR drivers are also interconnected, as these range from agricultural overuse, clinical misuse, environmental contamination, and socioeconomic inequalities that require a cross-sectoral and comprehensive response. The global and national strategies include WHO’s GAP, ASPs, and NAPs. Additionally, AMR can be tackled with technical and scientific solutions as it requires interdisciplinary collaboration, sustained political will, and community engagement. International organizations, governments, researchers, health care providers, and the public can work together with the One Health approach to effectively preserve existing antimicrobials and promote new intervention development.

References

1. Murugaiyan J, Kumar PA, Rao GS, Iskandar K, Hawser S, Hays JP, et al. Progress in alternative strategies to combat antimicrobial resistance: focus on antibiotics. Antibiotics. 2022;11(2):200. https://doi.org/10.3390/antibiotics11020200
2. Salam MA, Al-Amin MY, Salam MT, Pawar JS, Akhter N, Rabaan AA, et al. Antimicrobial resistance: a growing serious threat for global public health. In: Healthcare. Vol. 11, No. 13. Multidisciplinary Digital Publishing Institute; 2023. p. 1946. https://doi.org/10.3390/healthcare11131946
3. Church NA, McKillip JL. Antibiotic resistance crisis: challenges and imperatives. Biologia. 2021;76(5):1535–50. https://doi.org/10.2478/s11756-021-00652-1
4. Duarte C, Rodrigues S, Afonso A, Nogueira A, Coutinho P. Antibiotic resistance in the drinking water: old and new strategies to remove antibiotics, resistant bacteria, and resistance genes. Pharmaceuticals. 2022;15(4):393. https://doi.org/10.3390/ph15040393
5. Ahmed SK, Hussein S, Qurbani K, Ibrahim RH, Fareeq A, Mahmood KA, et al. Antimicrobial resistance: impacts, challenges, and prospects. J Med Surg Public Health. 2024;2:100081. https://doi.org/10.1016/j.jmsph.2024.100081
6. Tang KW, Millar B, Moore C, JE J. Antimicrobial resistance (AMR). Br J Biomed Sci. 2023;80:11387. https://doi.org/10.1080/09674845.2023.11387
7. Aslam B, Asghar R, Muzammil S, Shafique M, Siddique AB, Khurshid M, et al. AMR and sustainable development goals: at a crossroads. Glob Health. 2024;20(1):73. https://doi.org/10.1186/s12992-024-01026-4
8. Muteeb G, Rehman MT, Shahwan M, Aatif M. Origin of antibiotics and antibiotic resistance, and their impacts on drug development: a narrative review. Pharmaceuticals. 2023;16(11):1615. https://doi.org/10.3390/ph16111615
9. Kejela T, Dekosa F. High prevalence of MRSA and VRSA among inpatients of Mettu Karl Referral Hospital, southwest Ethiopia. Trop Med Int Health. 2022;27(8):735–41. https://doi.org/10.1111/tmi.13799
10. 1Rabaan AA, Eljaaly K, Alhumaid S, Albayat H, Al-Adsani W, Sabour AA, et al. An overview on phenotypic and genotypic characterisation of carbapenem-resistant Enterobacterales. Medicina. 2022;58(11):1675. https://doi.org/10.3390/medicina58111675
11. Duffey M, Shafer RW, Timm J, Burrows JN, Fotouhi N, Cockett M, et al. Combating antimicrobial resistance in malaria, HIV and tuberculosis. Nat Rev Drug Discov. 2024;23(6):461–79. https://doi.org/10.1038/s41573-024-00799-6
12. Gajic I, Tomic N, Lukovic B, Jovicevic M, Kekic D, Petrovic M, et al. A comprehensive overview of antibacterial agents for combating multidrug-resistant bacteria: the current landscape, development, future opportunities, and challenges. Antibiotics. 2025;14(3):221. https://doi.org/10.3390/antibiotics14030221
13. Sulis G, Sayood S, Gandra S. Antimicrobial resistance in low- and middle-income countries: current status and future directions. Expert Rev Anti Infect Ther. 2022;20(2):147–60. https://doi.org/10.1080/14787210.2022.1987467
14. Saleem Z, Mekonnen BA, Orubu ES, Islam MA, Nguyen TTP, Ubaka CM, et al. Current access, availability and use of antibiotics in primary care among key low- and middle-income countries and the policy implications. Expert Rev Anti Infect Ther. 2025;1–42. https://doi.org/ 10.1080/14787210.2025.2477198
15. Kim D, Yoon EJ, Hong JS, Choi MH, Kim HS, Kim YR, et al. Major bloodstream infection-causing bacterial pathogens and their antimicrobial resistance in South Korea, 2017–2019: phase I report from Kor-GLASS. Front Microbiol. 2022;12:799084. https://doi.org/10.3389/fmicb.2021.799084
16. Tesfa T, Mitiku H, Edae M, Assefa N. Prevalence and incidence of carbapenem-resistant K. pneumoniae colonisation: systematic review and meta-analysis. Syst Rev. 2022;11(1):240. https://doi.org/10.1186/s13643-022-02110-3
17. Flynn CE, Guarner J. Emerging antimicrobial resistance. Mod Pathol. 2023;36(9):100249. https://doi.org/10.1016/j.modpat.2023.100249
18. Codda G. Next generation sequencing-based detection and characterisation of microbial pathogens causing invasive infections and outbreaks in ICU: towards improved management of the high-risk patient. University of Genoa Institute; 2024.
19. Robillard DW, Sundermann AJ, Raux BR, Prinzi AM. Navigating the network: a narrative overview of AMR surveillance and data flow in the United States. Antimicrob Steward Healthc Epidemiol. 2024;4(1):e55. https://doi.org/10.1017/ash.2024.64
20. Mader R, Damborg P, Amat JP, Bengtsson B, Bourély C, Broens EM, et al. Building the European antimicrobial resistance surveillance network in veterinary medicine (EARS-Vet). Eurosurveillance. 2021;26(4):2001359. https://doi.org/10.2807/1560-7917.ES.2021.26.4.2001359
21. Frost I, Kapoor G, Craig J, Liu D, Laxminarayan R. Status, challenges and gaps in antimicrobial resistance surveillance around the world. J Glob Antimicrob Resist. 2021;25:222–6. https://doi.org/10.1016/j.jgar.2021.03.016
22. WHO. GLASS country participation; 2024 [Accessed 26 May 2025]. Available from: https://www.who.int/initiatives/glass/country-participation
23. Wheeler NE, Price V, Cunningham-Oakes E, Tsang KK, Nunn JG, Midega JT, et al. Innovations in genomic antimicrobial resistance surveillance. Lancet Microbe. 2023;4(12):e1063–70. https://doi.org/10.1016/S2666-5247(23)00285-9
24. Elyan E, Hussain A, Sheikh A, Elmanama AA, Vuttipittayamongkol P, Hijazi K. Antimicrobial resistance and machine learning: challenges and opportunities. IEEE Access. 2022;10:31561–77. https://doi.org/10.1109/ACCESS.2022.3160213
25. Ren Y, Chakraborty T, Doijad S, Falgenhauer L, Falgenhauer J, Goesmann A, et al. Prediction of antimicrobial resistance based on whole-genome sequencing and machine learning. Bioinformatics. 2022;38(2):325–34. https://doi.org/10.1093/bioinformatics/btab681
26. Aremu SO, Oruye ML, Adamu EI, Vuetkung NM, Jonathan DA, Matthew G, et al. Application of diagnostic network optimisation [DNOs] to tackle antimicrobial resistance in Sub-Saharan Africa. Discov Public Health. 2025;22(1):1–18. https://doi.org/10.1186/s12982-025-00689-1
27. Rony MKK, Sharmi PD, Alamgir HM. Addressing antimicrobial resistance in low and middle-income countries: overcoming challenges and implementing effective strategies. Environ Sci Pollut Res. 2023;30(45):101896–901. https://doi.org/10.1007/s11356-023-29434-4
28. Iskandar K, Molinier L, Hallit S, Sartelli M, Hardcastle TC, Haque M, et al. Surveillance of antimicrobial resistance in low- and middle-income countries: a scattered picture. Antimicrob Resist Infect Control. 2021;10:1–19. https://doi.org/10.1186/s13756-021-00931-w
29. Delpy L, Astbury CC, Aenishaenslin C, Ruckert A, Penney TL, Wiktorowicz M, et al. Integrated surveillance systems for antibiotic resistance in a One Health context: a scoping review. BMC Public Health. 2024;24(1):1717. https://doi.org/10.1186/s12889-024-19158-6
30. Vidhamaly V, Bellingham K, Newton PN, Caillet C. The quality of veterinary medicines and their implications for One Health. BMJ Glob Health. 2022;7(8):e008564. https://doi.org/10.1136/bmjgh-2022-008564
31. Chua AQ, Verma M, Hsu LY, Legido-Quigley H. An analysis of national action plans on antimicrobial resistance in Southeast Asia using a governance framework approach. Lancet Reg Health West Pac. 2021;7:100084. https://doi.org/10.1016/j.lanwpc.2020.100084
32. Kaprou GD, Bergšpica I, Alexa EA, Alvarez-Ordóñez A, Prieto M. Rapid methods for antimicrobial resistance diagnostics. Antibiotics. 2021;10(2):209. https://doi.org/10.3390/antibiotics10020209
33. Fleck A. Deaths from drug-resistant infections set to Skyrocket; 2023 [Accessed 26 May 2025]. Available from: https://www.statista.com/chart/3095/drug-resistant-infections/
34. Hosain MZ, Kabir SL, Kamal MM. Antimicrobial uses for livestock production in developing countries. Vet World. 2021;14(1):210. https://doi.org/10.14202/vetworld.2021.210-221
35. Yin L, Wang X, Liu LYZ, Mei Q, Chen Z. Uptake of the plant agriculture-used antibiotics oxytetracycline and streptomycin by cherry radish-effect on plant microbiome and the potential health risk. J Agric Food Chem. 2023;71(11):4561–70. https://doi.org/10.1021/acs.jafc.3c01052
36. Gwenzi W. Leaving no stone unturned in light of the COVID-19 faecal-oral hypothesis? a water, sanitation and hygiene (WASH) perspective targeting low-income countries. Sci Total Environ. 2021;753:141751. https://doi.org/10.1016/j.scitotenv.2020.141751
37. Abosse JS, Megersa B, Zewge F, Eregno FE. Healthcare waste management and antimicrobial resistance: a critical review. J Water Health. 2024;22(11):2076–93. https://doi.org/10.2166/wh.2024.232
38. Li W, Huang T, Liu C, Wushouer H, Yang X, Wang R, et al. Changing climate and socioeconomic factors contribute to global antimicrobial resistance. Nat Med. 2025;31:1789–808. https://doi.org/10.1038/s41591-025-03629-3
39. Health Developments. Why antimicrobial resistance (AMR) calls for a multisectoral one health approach – NOW; 2022 [Accessed 26 May 2025]. Available from: https://health.bmz.de/stories/why-antimicrobial-resistance-amr-calls-for-a-multisectoral-one-health-approach-now/
40. Ahmed SM, Naher N, Tune SNBK, Islam BZ. The implementation of National Action Plan (NAP) on antimicrobial resistance (AMR) in Bangladesh: challenges and lessons learned from a cross-sectional qualitative study. Antibiotics. 2022;11(5):690. https://doi.org/10.3390/antibiotics11050690
41. Hwang S, Kwon KT. Core elements for successful implementation of antimicrobial stewardship programs. Infect Chemother. 2021;53(3):421. https://doi.org/10.3947/ic.2021.0093
42. Barlam TF. The state of antibiotic stewardship programs in 2021: the perspective of an experienced steward. Antimicrob Steward Healthc Epidemiol. 2021;1(1):e20. https://doi.org/10.1017/ash.2021.180
43. Tauman AV, Robicsek A, Roberson J, Boyce JM. Health care-associated infection prevention and control: pharmacists’ role in meeting National Patient Safety Goal 7. Hosp Pharm. 2009;44(5):401–11. https://doi.org/10.1310/hpj4405-401
44. Piddock LJ, Alimi Y, Anderson J, de Felice D, Moore CE, Røttingen JA, et al. Advancing global antibiotic research, development and access. Nat Med. 2024;30(9):2432–43. https://doi.org/10.1038/s41591-024-03218-w
45. Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, et al. Strategies to improve antimicrobial utilisation with a special focus on developing countries. Life. 2021;11(6):528. https://doi.org/10.3390/life11060528
46. Wu D, Walsh TR, Wu Y. World Antimicrobial Awareness Week 2021—spread awareness, stop resistance. China CDC Wkly. 2021;3(47):987. https://doi.org/10.46234/ccdcw2021.241
47. Banerjee D, Raghunathan A. Knowledge, attitude and practice of antibiotic use and antimicrobial resistance: a study post the ‘Red Line’ initiative. Curr Sci. 2018;114(9):1866–77. https://doi.org/10.18520/cs/v114/i09/1866-1877
48. Eriksen J, Björkman I, Röing M, Essack SY, Stålsby Lundborg C. Exploring the One Health perspective in Sweden’s policies for containing antibiotic resistance. Antibiotics. 2021;10(5):526. https://doi.org/10.3390/antibiotics10050526
49. Gilchrist CA, Turner SD, Riley MF, Petri WA Jr, Hewlett EL. Whole-genome sequencing in outbreak analysis. Clin Microbiol Rev. 2015;28(3):541–63. https://doi.org/10.1128/CMR.00075-13

Cite this article as:
Ahmed R. Emerging Trends in Antimicrobial Resistance: A Global Review of Surveillance, Challenges, and Strategies. Premier Journal of Public Health 2025;4:100023

Export to EndNote Export to Mendeley