Antimicrobial resistance in Pakistan and global context

Abstract

One of the most important global health issues of the twenty-first century is antimicrobial resistance (AMR), and because of its distinct epidemiological and socioeconomic setting, Pakistan is particularly vulnerable. This thorough analysis summarizes the most recent data on AMR trends from 2020 to 2025, looking at both worldwide trends and issues unique to Pakistan. According to global surveillance data, the number of resistant infections has increased by 65% since 2000, and AMR is responsible for 4.95 million fatalities each year. With more than 50% of important bacteria, including Escherichia coli and Klebsiella pneumoniae, resistant to third-generation cephalosporins and fluoroquinolones, Pakistan exhibits startlingly high resistance rates. Overall, carbapenem resistance in K. pneumoniae has increased to 25.6%, with rates as high as 44.2% in bloodstream isolates. Due to the shortcomings of its healthcare system, Pakistan is expected to bear a disproportionate amount of the global economic burden, which is estimated to be between $100 and $150 billion. Enzymatic inactivation, target alteration, decreased permeability, active efflux, and biofilm formation are important resistance mechanisms. Significant obstacles to Pakistan’s National Action Plan execution include insufficient stewardship initiatives, regulatory deficiencies, and shoddy surveillance systems. With pediatric point-prevalence surveys revealing an 82.1% antibiotic use prevalence and only 2% culture-guided prescribing, antibiotic consumption has increased by an estimated 65% nationwide. One Health principles must be part of future plans, as they will lead to the strengthening of the lab networks; strict policies must be enforced more and should strengthen stewardship initiatives. This offers evidence-based recommendations for the prevention of AMR through coordinated national and international initiatives and highlights the critical necessity for extensive interventions across healthcare, agriculture, environmental, and policy domains.