Antimicrobial resistance: Analyzing a global health threat

Priya Nori, MD
_{© Montefiore Health System}

Antibiotics were one of the greatest medical developments of the 20^th century.

But without proper management, they could become far less effective for patient care – and infectious diseases could become far more difficult to treat.

Even upon the discovery and earliest use of antibiotics, scientists have known germs could evolve to develop immunity against them. Known as antimicrobial resistance (AMR), experts warn this could be one of the greatest health threats of the 21^st century.

It’s a global fight, and primary care physicians have a role at their local levels, in offices and hospitals around the nation, said Priya Nori, MD, the medical director of antimicrobial stewardship at the Montefiore Health System in the Bronx, New York.

It’s a big issue, and Nori spoke with Medical Economics to discuss AMR within the state of medicine as of late 2024 and early 2025. In this introduction, she discussed how it is an issue across medicine and health care. She also referred to a landmark study, “Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050,” published in fall 2024 by The Lancet.

This transcript has been edited for length and clarity.

Medical Economics: Can you discuss, the current state of medicine and health care regarding AMR? How do you describe the scope and scale of the problem?

Priya Nori, MD: The way I think about AMR, or antimicrobial resistance, is at a very broad level, at a societal and public health level, to a very narrow, patient-by-patient, individual hospital, individual clinic level. So it's very much a kind of upside down triangle. At the very top, there are recently published very alarming statistics to say that this is an ever-present problem. It's an increasing problem, and it really affects every single country, but perhaps some more than others. In terms of the global burden of AMR what this study showed was that there are over a million deaths annually over the past few decades, and this number is expected to increase by 2050 to close to 2 million deaths annually, and the populations that are having the biggest toll in terms of incidence of AMR-related illness and death is really the population that's 70 and above, and specifically those in lower and middle income countries, for various reasons. And these reasons include infrastructure around health care and antibiotic stewardship, infection prevention, surveillance programs for AMR, hand hygiene programs, and all of the things that we rely on in the western world to help control antibiotic resistance.

Other alarming statistics have to do with the financial toll of AMR. So this is going to cost billions to trillions of dollars over the next decade. It's already costing places like the U.S. close to $5 billion per year, and these are largely preventable conditions, and that's what's very important to know. With things like good antibiotic stewardship, hand hygiene, vaccination programs, we can really bring this burden down. At a societal level, there are certain things that I think we all really need to pay attention to, which do contribute to an increased burden of AMR and these are things that we hear about every day in the news. These are human conflict, conflict zones, civil wars. Regions such as the the Middle East and Ukraine, unfortunately, due to war traumas, are seeing an increased burden of antibiotic resistance and even vaccine-preventable conditions. So that's human conflict.

We also have displacement of peoples due to poor conditions at home, and they often do not have access to health care. They often can spread antibiotic resistant infections around in their very close quarters, and so that is a public health issue that we need to pay attention to and provide good care for those folks.

Vaccines: There is a linkage. There are published studies showing that decrease in vaccine uptake does contribute to an increase in antibiotic resistance, and this is because, if you think about it, when we prevent illnesses like the flu or pneumococcal pneumonia or rotavirus or other vaccine preventable things, we decrease the burden of antibiotic use because people are not presenting to health care clinics and hospitals with fevers, with infectious conditions that may lead to antibiotic exposure. So there's a direct link between vaccinating as many folks as we can and and reducing the burden of AMR.

These are the big societal public health issues. The last one I would throw in there, which is pertinent to antibiotic use outside of human health, is that in the environment, in livestock and agriculture, antibiotic use there has significantly contributed to the global burden of antibiotic resistance, because, according to the concept of One Health, all of these things are are directly linked. The environment, animal health, human health, it's all a continuum. And so if we're breeding antibiotic resistance, let's say, in livestock or poultry, then that can easily spread to the human consumers of those products. We see that with antibiotic resistance, but we also see that with a closely related issue of emerging viral respiratory illnesses such as the bird flu crisis that we are grappling with currently in the United States. So all of these things are very closely linked.

And then if you focus in from the big societal issues to the hospital level or clinic level issues, and then the individual patient, thankfully, that is a space where we have a little bit more control. In hospitals throughout the world, but especially in the Western world, we have programs such as infection prevention and control programs and antibiotic stewardship programs whose job is to make sure that we are reducing antibiotic overuse, preventing the spread of antibiotic resistant infections, preventing the occurrence of health care associated infections, which are often due to antibiotic resistant infections, and we're helping the frontline providers in the emergency department, in the clinics, in the ORs, we're helping everybody do the right thing as pertains to patient safety and preventing antibiotic resistance. So there's a lot to be done. You can see that there's interventions that can be done at each specific level.