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INTRODUCTION
The recent global coronavirus disease 2019 (COVID-19) pandemic had a tremendous impact within a relatively short period of time. However, behind this event lies another pandemic that has been progressing quietly over a long time span—one that is more serious in nature: antimicrobial resistance (AMR). AMR has been designated by the World Health Organization (WHO) as a top-priority public health crisis threatening human health.1 It is estimated that approximately 1.27 million people died directly due to AMR in 2019 alone, surpassing the annual death toll from HIV/AIDS and malaria. When including indirect mortality, the number rises to around 5 million. Furthermore, projections suggest that by 2050, AMR could cause up to 10 million deaths annually, potentially surpassing cancer as a leading cause of mortality.2
In short, AMR can be regarded as a chronic and fatal “real” pandemic, unlike acute infectious diseases like COVID-19 that spread explosively over a short time. Most importantly, this pandemic is far from over, and there are no signs of its abating any time soon.
This review aims to examine the historical development and current status of AMR, to assess the global and Korean epidemiology of multidrug-resistant organisms (MDROs), and to discuss strategic responses and future perspectives. Particular focus is placed on the spread of carbapenem-resistant Enterobacteriaceae (CRE), especially carbapenemase-producing Enterobacteriaceae (CPE), with an analysis of regional epidemiological trends and a more detailed look at the Korean situation. Finally, the necessary components of the response will be explored, including infection control, therapeutic approaches, alternative therapies (e.g., bacteriophage therapy), and antibiotic development, while also proposing policy tasks and strategic directions that highlight the essential role of infectious disease specialists.
HISTORY OF AMR
At the beginning of the 20th century, humanity seemed to achieve a remarkable victory over bacterial infections through the successive development of antimicrobial agents, starting with salvarsan and sulfonamides, and culminating in the discovery of penicillin by Alexander Fleming in 1928.3 However, the so-called “arms race” between antibiotics and bacteria had been anticipated from the outset. Notably, in his 1945 Nobel Prize acceptance speech, Fleming warned that the use of antibiotics in insufficient concentrations could lead to the emergence of resistant bacteria—a prescient concern expressed even before antibiotics were widely distributed.4
Indeed, as he predicted, penicillin-resistant Staphylococcus aureus was first reported in the 1940s, and methicillin, developed in response, was rendered ineffective by the emergence of methicillin-resistant S. aureus (MRSA) just two years after its introduction in 1961.5 MRSA subsequently spread globally and became a major cause of nosocomial infections, representing one of the most well-known “superbugs.”
Resistance to vancomycin, once considered a last-resort antibiotic, also emerged. In the late 1980s, vancomycin-resistant Enterococcus (VRE) was reported,6 followed in the 21st century by vancomycin-resistant S. aureus.7 In gram-negative bacteria, extensive use of third-generation cephalosporins led to the emergence of extended-spectrum beta-lactamase (ESBL)-producing strains,8 and resistance to carbapenems quickly followed. Carbapenemase enzymes, starting with Klebsiella pneumoniae carbapenemase (KPC), spread worldwide,9 while NDM-1 (New Delhi metallo-beta-lactamase), first discovered in India in 2008,10 became a predominant resistance mechanism across South Asia.11
In 2001, the OXA-48 enzyme was first identified in Türkiye and subsequently became endemic in parts of the Middle East and Southern Europe.12 Further, the discovery in China in 2015 of the mcr-1 gene, which confers plasmid-mediated resistance to polymyxin-class antibiotics such as colistin, marked the emergence of resistance even to what was considered a “last-resort” drug.13
This pattern—whereby resistance rapidly follows the introduction of a new antibiotic—has repeated itself throughout history. Currently, pathogens exhibit resistance to nearly all major classes of antibiotics, from penicillin to carbapenems and colistin, and have evolved into MDROs. This historical trajectory reveals that AMR is not an isolated or exceptional phenomenon but rather an inevitable biological process of microbial evolution. Therefore, it should not be viewed as an accidental disaster, but rather as a structural and long-term challenge that mandates strategic, systematic responses.
GLOBAL STATUS OF MDROs
MDROs are now widely prevalent not only in healthcare settings but also throughout communities worldwide, posing an increasing clinical and socioeconomic burden. Representative superbugs include MRSA, previously mentioned, as well as ESBL-producing Enterobacteriaceae (mainly Escherichia coli and Klebsiella spp.), VRE, and multidrug-resistant gram-negative bacilli such as MDR Pseudomonas aeruginosa and MDR Acinetobacter baumannii.2
Among them, the pathogens classified by the WHO as “the most critical group” are CRE, carbapenem-resistant P. aeruginosa, and carbapenem-resistant A. baumannii (CRAB), which are high-risk resistant organisms for which existing treatment options are largely ineffective.14
In the European Union, approximately 670,000 infections due to AMR were reported in 2015 alone, resulting in an estimated 33,000 deaths.15 According to the U.S. Centers for Disease Control and Prevention (CDC), more than 2.8 million cases of resistant infections and over 35,000 associated deaths occurred in 2019,16 and these numbers are expected to continue rising.
The burden of AMR is not confined to any single country or region. Rather, it spans across Europe, the Americas, Asia, the Middle East, and Africa. Although the distribution and patterns of resistant organisms differ by region, the spread of MDROs has already taken on the characteristics of a global pandemic that transcends borders.2 This crisis should not be regarded merely as an infectious disease concern, but as a structural problem capable of inflicting long-term harm on health systems and national economies.
REGIONAL STATUS OF MDROs BY CONTINENT
Asia
Asia has been recognized as a major origin of AMR worldwide. According to a meta-analysis, the prevalence of CRE infections in hospitals across South Asia was reported at 66.0%, the highest rate globally.17 In India, the spread of the NDM gene began in earnest around 2006, and among 235 Enterobacteriaceae isolates collected in 2009, 28% carried carbapenemase genes, with more than half identified as NDM-1.18 As a result, the rate of CRE infections in India reached 67.6%.17
In China, the prevalence of CRE is also rapidly increasing across various healthcare institutions, while Taiwan reported a CRE prevalence of 67.5% among K. pneumoniae infections, making it one of the highest in Asia alongside India.17
In summary, Asia stands as one of the epicenters of the global MDRO pandemic, with CRE posing the most significant concern.
Europe
According to the 2023 report from the European Antimicrobial Resistance Surveillance Network (EARS-Net) of the European Centre for Disease Prevention and Control (ECDC), AMR—including resistance to cephalosporins—remains high across the European Union/European Economic Area (EU/EEA).18 A joint summary report from the European Food Safety Authority (EFSA) and ECDC, based on data from 33 European countries from 2022 to 2023, also showed high levels of resistance in key bacterial pathogens found in both humans and animals, as well as in food.19 The persistently high levels of resistance to cephalosporins in recent years indicate that the issue remains serious and ongoing.
Furthermore, a marked geographic disparity exists, with the highest estimated incidence rates of antimicrobial-resistant bloodstream infections reported in Southern and Southeastern Europe. This suggests the potential influence of region-specific factors on resistance trends.20 The ECDC has warned that CRE infections are rising rapidly in several European countries and that this trend poses a growing threat to healthcare systems across the region. Since the ECDC’s latest risk assessment in 2019, signs of worsening CRE epidemiology have been observed in the EU/EEA.21
In 2023, the incidence of carbapenem-resistant K. pneumoniae bloodstream infections across the EU was estimated at 3.97 per 100,000 population, representing a 57.5% increase compared to 2019.18 This sharp rise in CRE prevalence in recent years underscores the pressing need for immediate public health interventions.
North America
According to the U.S. CDC reports from 2019 and the 2021–2022 updates, the major MDROs of concern in the United States include CRE, MRSA, VRE, and Candida auris.2223 The CDC has particularly emphasized the impact of the COVID-19 pandemic on trends in AMR in the U.S., noting that increased antibiotic use and challenges in infection control may have contributed to rising resistance rates.23
Similarly, the Public Health Agency of Canada (PHAC), through its Canadian Antimicrobial Resistance Surveillance System (CARSS), has closely monitored the status of MDROs in the country.24 The CARSS reports indicate increasing trends in infections due to VRE and CPE, in contrast to more stable or declining trends in healthcare-associated MRSA. The reports also highlight rising resistance in Neisseria gonorrhoeae and multidrug-resistant Streptococcus pneumoniae, underscoring that AMR is expanding beyond hospital settings into community-acquired infections.
Taken together, the most commonly encountered MDROs in North America include MRSA, VRE, CRE, and Clostridioides difficile.
The prevalence of CRE in the U.S. had been declining from 2016 to 2020, but during the COVID-19 pandemic, CRE infections in hospitals increased again, suggesting that the earlier downward trend may have been temporary.23 VRE continues to rise steadily in the U.S., while clinical cases of Candida auris have increased approximately fivefold from 2019 to 2022, raising significant concern.25
Central and South America
In Mexico, CRE—including strains producing NDM, OXA-48, and KPC carbapenemases—has become increasingly widespread in both hospital and community settings.262728
Guatemala has also reported high resistance rates, including to carbapenems, particularly in pediatric blood cultures and among both hospital and community-acquired infections. Pediatric populations remain especially vulnerable.29
Honduras lacks a comprehensive national surveillance system, but multidrug-resistant strains such as A. baumannii have emerged as major concerns.30 In Nicaragua, high resistance rates of E. coli and the presence of NDM-producing strains have been reported.31
Argentina faces significant challenges with MDR A. baumannii and CPE, while Brazil also contends with CRE, MRSA, and CRAB as major resistance issues.3233
The situation in Central and South America is severe, with considerable variability in prevalence, trends, contributing factors, and control strategies across countries. Although many countries in the region have developed national action plans, implementation has been hampered by insufficient surveillance infrastructure and limited resources.
Middle East and Africa
Although limitations in surveillance make it difficult to fully quantify the burden in the Middle East and Africa, available reports suggest that the CRE situation in the Middle East is also quite serious. A meta-analysis estimated the prevalence of hospital-acquired CRE infections in North Africa and the Middle East at approximately 26.6%.17
The most common types of MDROs in the Middle East include ESBL-producing Enterobacteriaceae (particularly E. coli and K. pneumoniae), MRSA, CRE, and MDR Acinetobacter and P. aeruginosa. In recent years, the prevalence of MDROs in this region has generally been increasing, with a particularly notable rise in carbapenem-resistant organisms.34
In Africa, the most common MDROs include ESBL-producing Enterobacteriaceae, MRSA, CRE, MDR Acinetobacter and P. aeruginosa, and multidrug-resistant Mycobacterium tuberculosis. The overall prevalence of MDROs has been increasing across the continent, with CRE and colistin-resistant organisms emerging as significant threats.3536 The region faces compounded challenges due to fragile healthcare infrastructure, highlighting the urgent need for global technical and financial support.
In summary, AMR has already spread across the globe, with each continent experiencing its own unique epidemiological characteristics and levels of crisis. The global spread of MDROs clearly indicates that a coordinated international response is essential to tackle this escalating public health emergency.
STATUS OF MDROs IN THE REPUBLIC OF KOREA
The Republic of Korea has been categorized as a country with a high prevalence of MDRO infections within healthcare institutions. In the early 2000s, MRSA and VRE were the predominant resistance issues in Korean hospitals. One study reported that the methicillin resistance rate among MRSA isolates was as high as 76.1% in 2008, although it declined to 62.5% by 2016.37 According to the 2017 national pathogen surveillance data, 53.2% of S. aureus bloodstream isolates were MRSA, and 34.0% of E. faecium isolates were VRE, reflecting persistently high levels.38 Furthermore, as of 2015, imipenem resistance was already observed in 35% of P. aeruginosa and 85% of Acinetobacter isolates, indicating a critical level of resistance among major gram-negative pathogens.39
The incidence of CRE in Korea has also increased dramatically. Since 2017, the Korea Disease Control and Prevention Agency (KDCA) has designated CRE infection as a notifiable Class 2 infectious disease, establishing a nationwide reporting and surveillance system. According to collected data, the number of reported CRE cases rose from approximately 8,000 in 2017 to 23,281 in 2021, and further surged to 30,548 in 2022. Notably, in 2022, CPE accounted for 21,695 cases, or 71.0% of all CRE notifications, representing a 46.9% increase from the previous year (14,769 cases in 2021).40
During the late 2010s, several cases of nosocomial infections due to NDM-1-producing Klebsiella pneumoniae were reported in large hospitals in the Seoul metropolitan area. New CPE types, including OXA-232, were also identified.41
K. pneumoniae remains the predominant pathogen among CRE cases in Korea. In 2022, K. pneumoniae accounted for approximately 72% of CRE isolates, followed by E. coli at 14%. The remaining isolates consisted of other Enterobacteriaceae such as the Enterobacter cloacae complex. The 2023 data continued to show a similar pattern, with K. pneumoniae (72.4%) and E. coli (14.1%) being the two most common species.42 This reflects that most CRE infections in Korea are K. pneumoniae infections occurring within healthcare institutions.
As for P. aeruginosa in Korea, the current carbapenem resistance rate remains around 30–35%. These strains also often exhibit concurrent resistance to other major antibiotic classes, leaving limited treatment options available.43
Korea’s incidence of CRE is considered high among Asian countries. For comparison, Japan reports approximately 1,600 CRE cases annually and has maintained relatively stable control.44 In contrast, Korea experiences tens of thousands of CRE cases each year, indicating a substantial disparity between the two countries.
In summary, the primary MDRO concerns in Korea have shifted from MRSA and VRE to CRE and multidrug-resistant gram-negative bacilli. The overall scale of the problem is also expanding. While government efforts—including disease notification systems and enhanced infection control policies—are in place, the prevalence of MDROs in clinical settings remains high. MRSA and VRE appear to be declining to some extent due to targeted control efforts, but the continued rise in CRE, MDR Pseudomonas, and Acinetobacter presents new and growing threats. Sustained surveillance and policy refinement are urgently needed.
STRATEGIC RESPONSES TO MDROs
Infection control strategies
Proactive infection control remains the most essential strategy to curb the spread of resistant organisms. Within hospital settings, strict adherence to standard precautions—such as hand hygiene and use of personal protective equipment—is critical. In high-risk wards, active surveillance strategies should be implemented to identify carriers of resistant organisms early and isolate them to prevent transmission.45
Antibiotic stewardship programs (ASPs) are another core element of infection control. The overuse and misuse of antibiotics are major contributors to the emergence of resistance. Therefore, ASPs led by infectious disease specialists should monitor and guide antibiotic prescribing practices. Through consistent feedback and collaboration, such teams can improve clinicians’ awareness and foster trust, ultimately driving meaningful changes in prescribing behavior.464748
Beyond hospitals, the One Health approach that encompasses communities and livestock sectors is essential. Even in Korea, antibiotics sometimes have been used in animal farming, and such use may contribute to the transmission of resistant organisms to humans. Accordingly, surveillance and regulation of antibiotic use must extend beyond human healthcare to include animals and the environment. Measures should also be taken at the food production stage to minimize contamination by resistant bacteria.49
These principles of infection control must be applied not only within hospitals, but also in community and zoonotic settings. A multilayered, sustained implementation of infection control strategies can decelerate the spread of resistant organisms and buy valuable time to develop effective countermeasures.
Clinical therapeutic approaches
For patients already infected with MDROs, it is essential to maximize the use of available therapeutic options to improve clinical outcomes. First, rapid and accurate diagnosis of both the infection site and the causative organism is critical. When an infection with a resistant organism is suspected, early specimen collection followed by culture and antimicrobial susceptibility testing should be performed. When necessary, molecular diagnostic methods may be used to identify resistance genes, allowing for timely transition to targeted therapy.
Second, repurposing of existing antibiotics and the use of combination therapy should be considered. For example, polymyxin-class agents such as colistin—previously abandoned due to nephrotoxicity—have reemerged as treatment options for CRE infections. Similarly, tigecycline, introduced in the late 2000s, is used against CRAB and other MDR infections.50 However, because monotherapy with these agents is often limited by low efficacy or suboptimal blood concentrations, combination regimens such as colistin + carbapenem or triple therapies including tigecycline or aminoglycosides have been explored in clinical settings, with some studies showing promising results.515253
Third, the use of newly developed antibiotics in other countries should be considered. Although treatment options remain limited compared to the past, several meaningful new drugs have been introduced over the past decade.54 For multidrug-resistant gram-positive bacteria such as MRSA and VRE, linezolid was introduced in Korea in the early 2000s, and daptomycin has also been approved. Other newer lipopeptides, such as telavancin and oritavancin, have been approved abroad. These agents offer pharmacokinetic advantages over vancomycin—such as extended half-life and improved tissue penetration—and are useful in treating MRSA and VRE infections.555657
For MDR gram-negative bacteria, especially CRE, newer β-lactam/β-lactamase inhibitor combinations have been developed.50 Notably, avibactam—a non-β-lactam β-lactamase inhibitor—has been combined with ceftazidime to create an agent effective against KPC and some OXA-48-producing strains, showing dramatic results in treating CRE infections.585960
Other combinations such as meropenem-vaborbactam and imipenem/cilastatin-relebactam have also proven effective against KPC-producing strains.6162 Cefiderocol, a siderophore cephalosporin, exploits the bacterial iron uptake pathway to enter the cell and has shown potent activity against resistant P. aeruginosa, A. baumannii, and CRE.63
Among carbapenemase types, metallo-β-lactamases remain the most difficult to treat. To address this, the combination of avibactam and aztreonam is emerging as a hopeful strategy.646566
These novel agents offer renewed hope for treating infections caused by MDR organisms. However, in Korea, only a limited number of these drugs have been approved for use, and many remain unavailable. Therefore, it is crucial to select the optimal combination of available drugs to maximize efficacy and, when necessary, consider individual importation of foreign-approved drugs through special access programs.
Ultimately, treating patients infected with MDR organisms in clinical practice requires both wise use of existing antibiotics and improved access to novel agents. In addition to antimicrobial therapy, source control and consultation with infectious disease specialists are critical to ensure comprehensive management.
Bacteriophage (phage) therapy
Among the alternative therapies drawing attention in the fight against AMR, bacteriophage (phage) therapy stands out as a promising candidate.67 Bacteriophages are viruses that specifically infect and destroy bacteria. Although phages were actively studied in the early 20th century before the antibiotic era, interest in them faded with the advent of antibiotics. However, the current AMR crisis has led to a resurgence of interest in phage therapy.686970
Phage therapy has several theoretical advantages. Its host specificity minimizes disruption to the human microbiota. In addition, phages can penetrate and act within bacterial biofilms—environments where antibiotics often fail—and even target bacteria that are resistant to conventional antibiotics, as long as they remain susceptible to the phage in question.67
Specialized centers for phage therapy have been established in countries such as the United States, Belgium, and Georgia, where numerous therapeutic attempts have been made. In particular, compassionate use cases targeting patients who failed conventional treatments have reported encouraging outcomes.677172
Nevertheless, several challenges must be overcome before phage therapy can become a standard treatment. Phages are often highly specific to bacterial species or even serotypes, requiring significant time and resources to identify and manufacture a suitable phage for a given infection. Data on their pharmacokinetics—how they behave and distribute within the human body—are also limited. Moreover, immune responses against phages or the emergence of phage-resistant bacterial mutants must be considered.
Clinical trials on phage therapy are expected to begin in Korea in the near future. If successful, they may offer a new therapeutic pathway for treating MDR bacterial infections.
STAGNATION IN ANTIBIOTIC DEVELOPMENT AND THE GLOBAL DRUG PIPELINE
One of the fundamental solutions to AMR lies in the development of new antibiotics. However, over the past several decades, global antibiotic development has faced significant stagnation. While major pharmaceutical companies introduced successive new antibiotic classes through the mid-20th century, the emergence of truly novel agents has been exceedingly rare since the 1980s.73
This stagnation is due to a complex combination of factors, foremost among them the lack of economic incentives. Antibiotics are typically prescribed for acute infections and taken for short durations. Even when new agents are developed, their use is intentionally minimized to prevent resistance, limiting market potential. In this “broken market,” pharmaceutical companies have increasingly withdrawn from antibiotic research and development, resulting in a shallow global pipeline.74 According to the WHO’s annual pipeline analysis reports, most antibiotics in development offer only incremental improvements on existing drugs, and truly novel agents capable of targeting lethal MDR pathogens remain extremely scarce.75
In summary, the stagnation in antibiotic development is a major contributor to the worsening AMR pandemic. To overcome this, not only scientific innovation but also systemic policy support is essential. Although a few promising candidates exist in the current global pipeline, their number is far from sufficient. In order to stay ahead of bacterial evolution, governments, academia, and industry must work together to rebuild the antibiotic development ecosystem.
BARRIERS TO DOMESTIC INTRODUCTION OF FOREIGN-DEVELOPED ANTIBIOTICS AND INSTITUTIONAL CHALLENGES
As discussed in the previous section, some new antibiotics have fortunately been approved and are in use abroad. However, patients in the Republic of Korea often face difficulties accessing these new drugs in a timely manner. This reality is shaped by a combination of factors, including regulatory approvals by health authorities, reimbursement policies, and the business strategies of pharmaceutical companies.54
First, regulatory and approval procedures present obstacles. During the Ministry of Food and Drug Safety (MFDS) approval process, additional domestic clinical data may be requested, and complex regulatory steps may delay approvals. While some preferential measures—such as shortened review periods—exist for antibiotics, reliance on global clinical trial data can be problematic. Even after approval, it often takes considerable time to finalize reimbursement decisions, further delaying real-world access.
Second, pharmaceutical companies' business considerations play a significant role. Multinational pharmaceutical firms assess market potential before launching new products, and Korea is sometimes viewed as a low-return market for antibiotics. This perception is driven by policy-led reductions in antibiotic usage, a preference for inexpensive generics, and anticipated restrictions on the use of high-cost agents for resistance management purposes. As a result, companies may hesitate to launch new antibiotics in Korea, fearing low uptake and limited revenue.
Once there was an economic evaluation system, it was abolished with the efforts and advice of infection experts, but it is still difficult to introduce new drugs because insurance does not provide the level of drug prices required by pharmaceutical companies.
To overcome these challenges, a cooperative approach between the government, insurers, and pharmaceutical companies is required. For critical antibiotics, exceptional reimbursement pathways or a special pricing scheme should be established to ensure patient access. Regulatory reforms that enable accelerated approval based on international clinical data—and minimize redundant local trials—are also needed.
In short, unless the domestic introduction of novel antibiotics is facilitated, treatment gaps for MDR infections will persist and pose risks to public health. Health authorities must establish targeted strategies to address this issue. Infectious disease experts also have a role to play in advocating for regulatory improvements and providing evidence to support policy change.
FUTURE OUTLOOK AND RECOMMENDATIONS - THE ROLE OF INFECTIOUS DISEASE SPECIALISTS
The pandemic of AMR is unlikely to end in the short term; indeed, it may become a challenge that humanity must coexist with permanently. Therefore, a long-term and sustainable response system must be established while continuing to explore new technologies and strategies. In this context, the roles to be fulfilled by infectious disease specialists can be summarized as follows:
First, leadership in ASPs and clinical practice
Infectious disease physicians must serve as key players in optimizing antibiotic use within hospitals. They are responsible for leading multidisciplinary teams, developing prescribing guidelines, and educating medical staff. Meta-analyses have confirmed that ASPs led by specialists result in reductions in antibiotic use and resistance rates.46 Consequently, it is necessary to mandate the implementation of ASPs in all general hospitals and to ensure that trained professionals are available. When new antibiotics or therapies are introduced, these experts must also take the lead in establishing proper usage policies to promote judicious use and maximize effectiveness.
Second, infection control and public health engagement
Infectious disease specialists serve as core members of hospital infection control committees. They develop and implement strategies for surveillance, isolation, and environmental management of MDROs, as well as staff education programs.76 Additionally, they contribute to national surveillance systems (e.g., Kor-GLASS) by supplying and analyzing data. When novel resistance organisms emerge, these experts conduct epidemiological investigations to block transmission. They also participate in developing guidelines for MDRO control in community and long-term care settings, and help lead public awareness campaigns on appropriate antibiotic use.
Third, contributions to research and innovation
Drawing upon clinical experience, infectious disease physicians must engage in or lead research efforts aimed at new therapeutic and diagnostic strategies. For instance, they play a key role in conducting clinical trials of new antibiotics among MDR infection patients, generating domestic data to support regulatory approval. Furthermore, they must collaborate on forward-looking innovations such as phage therapy, vaccine development, and immunotherapy by providing clinical insights.
Fourth, policy advisory and advocacy
Addressing AMR requires not only scientific approaches but also political will and resource allocation. Infectious disease specialists must provide evidence-based recommendations to policymakers and help ensure that regulations and strategies are grounded in sound science. They must actively communicate with governmental agencies regarding the barriers and urgency of antibiotic access.
Fifth, workforce development
It is imperative to train and expand the pool of infectious disease specialists and related experts. Educational programs for existing healthcare workers on prudent antibiotic use must also be strengthened.
Lastly, leadership in multidisciplinary collaboration
No single profession can solve the problem of AMR alone. Collaboration across disciplines—including clinical pharmacologists, pharmacists, microbiologists, nurses, environmental health professionals, and so on—is essential. Infectious disease specialists should serve as coordinators and facilitators among these groups, leading integrated One Health initiatives.
CONCLUSION
AMR is a silent yet deadly pandemic that has already spread extensively across the globe and will remain a complex public health crisis for decades to come. As the effectiveness of traditional antibiotics continues to decline, the response to MDROs must involve interventions at multiple levels—ranging from infection prevention and treatment strategies to drug development, policy reform, and international collaboration.
This review has examined the history and current state of AMR, the global and national trends in MDROs, and the clinical and policy-level strategies for response. In particular, I have emphasized the critical role of infectious disease specialists, whose responsibilities now extend beyond treatment to include leadership, research, policy advising, and education.
Moving forward, the following principles must guide future strategy:
First, infection control and the optimization of antibiotic use remain our most powerful defenses against resistance.
Second, in addition to maximizing the effectiveness of existing drugs, support systems must be established for the development and adoption of new agents and alternative therapies.
Third, regulatory and reimbursement frameworks must be reformed to ensure that globally approved antibiotics are made promptly accessible to domestic patients.
Fourth, enhanced surveillance and robust expert networks must support scientific and data-driven policy decisions.
Above all, AMR must no longer be viewed as the responsibility of a single department or academic discipline. It must be recognized as a national crisis and a comprehensive challenge to the entire public health system. Government, academia, healthcare, and industry must share responsibility and work together in a coordinated manner.
The time for warnings is over. We must move toward implementation. The “post-antibiotic era,” once considered a theoretical threat, is now a present reality. Only decisive action will allow us to overcome it.
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