Bacterial Antibiotic Resistance as a Global Public Health Threat: Drivers, Mechanisms, Priority Pathogens and Control Strategies: A Narrative Review
Iortsor Iwanger Bright
*
Department of Medical Biotechnologies, School of Medicine, University of Siena, Siena, Italy.
*Author to whom correspondence should be addressed.
Abstract
Background: Bacterial antibiotic resistance is a growing global public health threat that reduces the effectiveness of treatment for common infections and increases the risks associated with surgery, cancer therapy, intensive care, and other medical interventions. Its emergence and spread are driven by antimicrobial selection pressure, bacterial adaptation, inappropriate antibiotic use, and transmission across human, animal, and environmental settings.
Aim: This narrative review examines the major drivers and mechanisms of bacterial antibiotic resistance, summarises resistance among clinically important pathogens, evaluates its public health consequences, and appraises current prevention and control strategies, with attention to low- and middle-income countries.
Methods: A structured, non-systematic literature search was conducted in June 2026 using Consensus, PubMed, Scopus, and Semantic Scholar, together with general web searches and the websites of the World Health Organization and the US Centers for Disease Control and Prevention. Priority was given to peer-reviewed studies, surveillance reports, and major reviews published from 2020 onward, while older seminal studies were retained where relevant.
Results: Approximately one in six laboratory-confirmed bacterial infections worldwide was resistant to treatment in 2023, while resistance increased in more than 40% of monitored pathogen-antibiotic combinations between 2018 and 2023. Resistance develops through enzymatic inactivation, target modification, reduced permeability, efflux, target bypass, mutation, and horizontal gene transfer. Carbapenem-resistant Gram-negative organisms, rifampicin-resistant Mycobacterium tuberculosis, and methicillin-resistant Staphylococcus aureus remain major clinical and public health concerns.
Conclusion: Bacterial antibiotic resistance is sustained by bacterial evolution and human-driven selection pressure, with the heaviest burden occurring where diagnostic, surveillance, and infection-control capacity are weakest. Containment requires coordinated antimicrobial stewardship, infection prevention and control, water and sanitation, vaccination, improved diagnostics, surveillance, responsible antibiotic use across sectors, and continued therapeutic innovation.
Keywords: Antibiotic resistance, antimicrobial resistance, multidrug resistance, antimicrobial stewardship, bacterial pathogens, one health, low- and middle-income countries, public health