One-sixth of confirmed bacterial infections are resistant to antibiotics and rates of drug-resistance are rapidly growing, presenting a growing threat to public health.

Over five years — from 2018 to 2023 — antibiotic resistance rose in over 40 percent of the monitored antibiotics with an average annual rise of 5 percent to 15 percent, found the World Health Organization report, published Monday.

The Global Antibiotic Resistance Surveillance Report tracked 22 key antibiotics used to treat infections caused by the eight most common bacterial pathogens, including urinary tract infections and gonorrhea.

Antimicrobial resistance (AMR) is one of the biggest public health threats of the 21st century and could make it much harder to treat everyday infections, according to the WHO. It’s mainly caused by the overuse and misuse of medicines, allowing pathogens to become resistant, and is fuelled by poor sanitation and lack of clean water. Bacterial AMR killed 1.27 million people in 2019 and contributed to another 4.95 million deaths that year.

“Antimicrobial resistance is outpacing advances in modern medicine, threatening the health of families worldwide,” said Tedros Adhanom Ghebreyesus, WHO director general. “As countries strengthen their AMR surveillance systems, we must use antibiotics responsibly, and make sure everyone has access to the right medicines, quality-assured diagnostics, and vaccines,” he added.

The median level of antibiotic resistance in Europe was 10.2 percent, the second-lowest rate of any region and below the global average of 17.2 percent. 

The greatest threat comes from gram-negative bacteria, which include E. coli and K. pneumoniae, and are among the most severe bacterial infections. More than 40 percent of E. coli and 55 percent of K. pneumoniae globally are resistant to the first-choice treatment, the report found.

Other concerns include the bacteria that causes gonorrhea, which has developed resistance to every drug available for first-line treatment. One drug, ciprofloxacin, is no longer suitable due to widespread resistance, while another, azithromycin, has been removed from routine therapy. Resistance to azithromycin is highest in the European region at almost 26 percent.

As bacteria become resistant to first-line antibiotics, doctors must increasingly rely on last-resort treatments, which are more expensive and harder to access, especially in low- and middle-income countries.

Development of new antibiotics has slowed to a halt due to the lack of a profitable market and incentives for private companies to invest in them. The European Commission has proposed an exclusivity “voucher” to incentivize companies that develop new antibiotics as part of its pharma package. The European Parliament also wants to introduce market entry rewards for new drugs and an EU subscription payment model — proposals that are currently under debate to upgrade EU pharma rules.

Other models, such as the Global Antibiotic Research and Development Partnership, seek to develop new antibiotics on a non-profit basis.