What is AMR and How Do We Track It?

Antimicrobial resistance is the reduced effectiveness of drugs against microorganisms such as bacteria, viruses, fungi, and parasites. The CDC calls it a significant public health problem which causes 2.8 million annual infections in the United States–increasing healthcare costs by $4.6 billion–and 1.27 million deaths globally. The growing burden AMR infections place on global healthcare systems has driven the development of surveillance networks which monitor changes in microbial populations. Observing these changes lets healthcare agencies detect drug-resistant microorganisms and genes or mechanisms that could enable resistance. Resistance data is collected across various environmental sources before being shared with public health and governmental stakeholders who work to form coordinated AMR responses.

Positive Public Health Implications of AMR Surveillance

AMR surveillance’s role as a warning system for potential health crises makes it a critical part of healthcare systems across the globe. Data gathered from regional samples and laboratory monitoring supports global health security and reduces burdens on healthcare systems by alleviating patient morbidity. It also provides evidence that lawmakers need to create new policy and clinical guidelines for fighting AMR.

Supports Global Health Security

The work that comprises AMR surveillance has proven useful across a variety of measures that keep global health systems running securely and efficiently. Its insights into resistance trends guide patient therapy, identify priorities for targeted antibiotics and diagnostic tools, and make it easy for drug prescription practices and infection control measures to be evaluated. These efforts have identified high priority pathogens and geographic regions where AMR is increasing most rapidly, allowing for the formation of Early Warning Systems (EWS) used across nations’ hospitals and community settings. Though gaps exist thanks to differences among each system’s organizational structure, alert mechanisms, and the organisms under surveillance, world leaders are working to shape them into a more unified defense. In September 2024, the United Nations General Assembly agreed to pledge $100 million to support funded national AMR action plans in at least 60% of countries by 2030. As part of this funding, nations will receive guidance on approaching AMR through a “One Health” framework which unites human health with animal and environmental factors.

AMR surveillance has also informed stewardship efforts which preserve the limited antimicrobial drug options available and keep them useful for as long as possible. Besides the threat of antimicrobial resistance, this work is critical because of how long it takes to develop new drugs and the promising results it has yielded in healthcare settings. Stewardship efforts make healthcare more cost-effective and improve patient quality of life by decreasing mortality rates and improving infection cure rates as well as dosing among those with renal impairments. 

Reduces Morbidity, Mortality, Healthcare Cost

Early detection from AMR surveillance prevents severe outcomes and reduces financial burdens on patients and healthcare facilities. Reduced healthcare costs enhance treatment options and ensure that limited funds are allocated to areas that need them most, improving healthcare systems’ ability to respond to AMR threats efficiently. Widespread cost reduction minimizes the economic burden posed by a  global emergence of resistant organisms. 

Informs Evidence-Based Policy and Clinical Guidelines

Data acquired from AMR surveillance guides research priorities, treatment protocols and regulatory action. In 2014, the White House released a National Strategy for Combating Antibiotic-Resistant Bacteria which recognized the federal government’s responsibility to detect, prevent, and control outbreaks of resistant organisms categorized as urgent or serious threats by the CDC. This strategy ensured the availability of effective drug treatments for AMR infections and strengthened systems that controlled and detected emerging AMR pathogens found in animals and humans. 

In 2015, the World Health Organization launched a Global Action Plan (GAP) which aimed to raise awareness of AMR by addressing its root causes and promoting appropriate use of antimicrobial drugs through three core workstreams: national action planning and evaluation, strengthening surveillance and laboratory protocols, and control and response strategies. Two years later, the WHO also developed the first bacterial priority pathogen list to propel development and research for new vaccines, diagnostic tools, and antimicrobials while promoting public health action. The list was updated in 2023.

Policy Challenges and Implementation Concerns

Though AMR surveillance leads to several benefits for patients and healthcare systems, widespread implementation remains challenging because of several logistical challenges that make policy harder to apply. Healthcare workers’ forced reliance on stronger antibiotics to fight antimicrobial resistance sees hospitals expend more resources in fighting it and sees patients exposed to more drastic side effects. Gaps in data introduced by variation in lab methods and resources also make it harder for surveillance systems to give accurate assessments of the issue.

High Cost and Resource Burden  

Antimicrobial resistance significantly increases healthcare costs by extending hospital stays, forcing more resources to be utilized on sick patients, and creating reliance on expensive second- and third-line antibiotics after other treatments fail. These antibiotics require higher doses or combination regimens and carry a greater risk of adverse effects. Increased morbidity and mortality extend AMR’s economic burden to patients, insurers, and society. A 2017 analysis of carbapenem-resistant Enterobacterales (CRE) estimated per-case costs of $13,701–$18,286 for patients or insurers and $22,993–$35,503 for hospitals. Assuming a 35% mortality rate, CRE infections were estimated to cause 1,131–5,790 deaths annually, resulting in societal costs such as diminished worker productivity and lost family income ranging from $681 million to $3.5 billion. 

Data Quality and Comparability Issues

Variability in laboratory methods limits the quality and comparability of AMR surveillance data. Differences in testing approaches such as automated systems, genotypic resistance detection, and laboratory capacity result in fragmented and incomplete datasets that hinder population-based surveillance. This limitation complicates policymakers’ ability to assess resistance trends and allocate resources. Data gaps were highlighted during a 2023 U.S. House Energy and Commerce Committee hearing where federal agencies acknowledged that key surveillance systems capture only an estimated 1–2% of U.S. drug-resistant Neisseria gonorrhoeae cases, making it difficult to develop more refined testing procedures and preventing doctors from understanding which treatment plan is best to prescribe. Resolving policy issues such as these hinges on updated AMR information.

Equity and Participation Challenges

Surveillance data often underrepresents marginalized populations who are disproportionately impacted by antimicrobial resistance due to geographic, socioeconomic, and ethnic barriers restricting access to health care. This lack of services most directly presents itself as a lack of access to effective antibiotics, but social inequalities can make marginalized populations more susceptible to acquiring AMR infections by preventing them from becoming aware of AMR and keeping them living in poor conditions. 

Resource shortages also leave low- and middle-income countries underrepresented in survey data even though they shoulder the highest burden of disease. This is equally due to the epidemiology of AMR and limitations on information about current geographical distributions of AMR that make it impossible to conduct comprehensive population surveillance. Even when enough information exists to support this level of monitoring, underdeveloped laboratory infrastructure prevents those countries’ scientists from carrying out the necessary tests. 

The data collection required for antimicrobial surveillance can also present logistical problems for low- and middle-income countries without proper automated systems frameworks. Limited IT infrastructure, connectivity, and workforce capacity undermine accurate burden estimates and create gaps which contribute to fragmented global surveillance. This phenomenon is reflected in issues with the World Health Organization’s Global Antimicrobial Resistance Surveillance System (GLASS). The program’s reliability and comparability is undermined by the fact that fewer than 50 of the 70 enrolled countries report consistently and often rely on small, self-reported data sets.

The Ongoing Challenge

Antimicrobial resistance poses a growing global public health threat which could surpass other leading causes of mortality by 2050 without effective prevention. AMR surveillance provides a path to that prevention by bolstering the security of global health systems and providing the evidence to support clinical guidelines reducing symptom morbidity, patient mortality, and the cost of healthcare. However, inequalities in laboratory facilities across the world create data gaps that make it difficult for politicians to determine how badly AMR affects different populations and which solutions they should use to address the issue. Limiting the progression of AMR requires sustained policy attention, adaptive clinical guidelines, adequate funding, and surveillance-informed workflows that strengthen health system capacity.

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