AMR Isn't Just Coming but Already Undermining Your Practice
AMR stems from the natural evolutionary ability of microbes to survive selective pressure from antimicrobials. This process is significantly accelerated by the overuse and misuse of these drugs in human health, veterinary medicine, and agriculture. Resistant infections often require longer treatment courses, are associated with increased disability and mortality, and lead to extended hospital stays and higher healthcare costs — placing a growing burden on health systems and global economies.
The CDC estimates at least 2.8 million resistant infections and over 35,000 related deaths annually in the US alone.
Resistance Mechanisms
AMR typically arises through two primary mechanisms: spontaneous genetic mutations and horizontal gene transfer (via conjugation, transformation, or transduction).
Recent findings outline several well-characterized resistance pathways:
Target modification: Structural alterations in drug targets — often key proteins or cell components — can prevent effective drug binding.
Enzyme production: Certain bacteria produce enzymes such as beta-lactamases that deactivate antibiotics like penicillins and cephalosporins. These enzymes are increasingly common in gram-negative species such as Escherichia coli and Klebsiella pneumoniae .
and . Efflux pumps and permeability barriers: Some bacteria limit drug entry or actively expel antibiotics using multidrug efflux pumps. This is particularly problematic in gram-negative organisms due to their additional outer membrane.
These resistance mechanisms can coexist within a single organism, giving rise to 'pan-resistant' strains that are unaffected by nearly all available antimicrobial agents.
Resistance can emerge rapidly — even during the course of treatment — turning previously susceptible infections resistant mid-therapy and narrowing treatment options dramatically.
Recent Trends and Global Data
New international data highlight the accelerating spread of AMR, with particularly concerning developments across both bacterial and fungal pathogens.
The World Health Organization (WHO)'s 2024 Bacterial Priority Pathogens List documented rising resistance rates in K pneumoniae and E coli , especially in Asia and Africa — regions where therapeutic options remain severely limited. These findings align with projections from a 2024 commentary published in The Lancet , which estimates that AMR could cause up to 10 million deaths annually by 2050, disproportionately affecting low- and middle-income countries.
In the US, the CDC reported that more than 35% of hospital-acquired urinary tract infections in 2024 were caused by multidrug-resistant (MDR) organisms. This surge is driven in large part by the horizontal transmission of resistance genes via mobile genetic elements such as plasmids and transposons.
MDR tuberculosis also continues to pose a serious global health threat. Data from Eastern Europe and parts of Asia show that over 20% of new tuberculosis cases now involve MDR strains. These cases require longer, more toxic regimens and are associated with poorer clinical outcomes, adding further strain to public health systems.
Fungal resistance is emerging as a parallel crisis. A recent review reported that more than 90% of Candida auris isolates collected from hospitals in Europe and North America were resistant to multiple antifungal agents. This poses a serious risk to patients who are immunocompromised and critically ill, particularly in ICUs where infection control remains challenging.
Despite the growing threat, treatment pipelines remain thin. While several new antimicrobial agents are under investigation, most remain in preclinical or early clinical stages. The report underscores an urgent need for sustained investment in antimicrobial drug development to replenish a shrinking therapeutic arsenal.
Adding to the concern, recent studies describe the emergence of novel resistance mechanisms in gram-positive pathogens such as methicillin-resistant Staphylococcus aureus . Some strains have developed traits that compromise the efficacy of even newly approved agents — further complicating treatment strategies and escalating costs of care.
As AMR continues to evolve across multiple fronts, these findings reinforce the need for comprehensive, coordinated strategies to monitor resistance patterns; support antimicrobial stewardship; and accelerate therapeutic innovation.
Economic Toll
The global economic impact of AMR could be staggering. The 2024 Lancet commentary projects that AMR could result in up to $100 trillion in economic losses by 2050. The burden is expected to fall disproportionately on low- and middle-income countries, where weaker health systems and limited access to effective therapies could exacerbate existing disparities in both health outcomes and economic development.
Clinical consequences are already evident in hospitals around the world. Recent research shows that resistant healthcare-associated infections — such as bloodstream infections and ventilator-associated pneumonias — are associated with mortality rates approaching 30% higher in patients in resource-limited settings. Contributing factors include poor hospital infrastructure, limited access to diagnostics and therapeutics, and inadequate infection control measures.
Meanwhile, a 2024 review highlights the growing threat of hospital-acquired infections caused by Acinetobacter baumannii and Pseudomonas aeruginosa — both of which exhibit high levels of resistance to multiple antibiotic classes. Without effective interventions, these infections may become increasingly difficult, if not impossible, to treat, further driving up hospital mortality and straining intensive care resources.
Emerging Strategies and Solutions
Several promising strategies are being explored to slow AMR progression and strengthen the clinical response.
Development of new antimicrobials: Recent research highlights novel compounds designed to overcome common resistance mechanisms. While early in development, these agents may offer new hope against multidrug-resistant pathogens.
Alternative therapies: Early-phase studies suggest that bacteriophage therapy and antibacterial nanoparticles could serve as complementary approaches to combat infections that no longer respond to conventional treatments. These technologies are gaining traction but require rigorous clinical validation.
Antimicrobial stewardship and surveillance: Effective stewardship programs remain central to the AMR response. Core components include the rational prescribing of antimicrobials, real-time infection surveillance, and access to rapid diagnostic tools for antimicrobial susceptibility testing.
Education and global awareness: The WHO and CDC continue to emphasize the need for coordinated global education campaigns to promote the appropriate use of antimicrobials and curb self-medication — particularly in countries with weak regulatory oversight.
National initiatives: In Spain, the 2025-2027 Plan Nacional frente a la Resistencia a los Antibióticos (National Plan against Antibiotic Resistance) stands out as a model. The plan includes enhanced epidemiologic surveillance, increased funding for antimicrobial research, ongoing training for healthcare providers, and public education campaigns. It also calls for integrated action across all levels of the health system to ensure a coordinated national response.
Conclusions
AMR is no longer a looming threat — it is a present-day global health emergency. Its continued spread is undermining the foundations of modern medicine, with far-reaching consequences for clinical care, public health, and global equity.
As resistance mechanisms become increasingly complex and widespread, the therapeutic arsenal is shrinking — particularly in hospital settings and for vulnerable populations. Meanwhile, antibiotic development continues to lag, with most new agents stalled in early-phase research.
To avoid a future where routine infections become untreatable, the global response must be ambitious and coordinated. Expanding antimicrobial stewardship, accelerating drug development through sustained investment, and enforcing rational prescribing practices are all urgent priorities. These efforts must be anchored in the One Health approach, which recognizes the interconnectedness of human, animal, and environmental health.
Education and behavior change are equally essential. Clinicians, patients, and policymakers all play a role in preserving the effectiveness of existing antimicrobials. And while emerging therapies such as phage therapy, nanomedicine, and immunomodulation offer hope, they require rigorous testing and clear regulatory pathways before they can be integrated into clinical practice.
The window for action is narrowing — but meaningful progress is still possible. With global alignment, scientific innovation, and sustained commitment, the trajectory of AMR can be reversed.
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WIRED
24 minutes ago
- WIRED
At Least 750 US Hospitals Faced Disruptions During Last Year's CrowdStrike Outage, Study Finds
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It reveals evidence that hundreds of those hospitals' services were disrupted during the outage, and raises concerns about potentially grave effects to patients' health and well-being. Researchers from the University of California San Diego today marked the one-year anniversary of CrowdStrike's catastrophe by releasing a paper in JAMA Network Open, a publication of the Journal of the American Medical Association Network, that attempts for the first time to create a rough estimate of the number of hospitals whose networks were affected by that IT meltdown on July 19, 2024, as well as which services on those networks appeared to have been disrupted. A chart showing a massive spike in detected medical service outages on the day of CrowdStrike's crashes. Courtesy of UCSD and JAMA Network Open By scanning internet-exposed parts of hospital networks before, during, and after the crisis, they detected that at minimum 759 hospitals in the US appear to have experienced network disruption of some kind on that day. They found that more than 200 of those hospitals seemed to have been hit specifically with outages that directly affected patients, from inaccessible health records and test scans to fetal monitoring systems that went offline. Of the 2,232 hospital networks they were able to scan, the researchers detected that fully 34 percent of them appear to have suffered from some type of disruption. All of that indicates the CrowdStrike outage could have been a 'significant public health issue,' argues Christian Dameff, a UCSD emergency medicine doctor and cybersecurity researcher, and one of the paper's authors. 'If we had had this paper's data a year ago when this happened," he adds, 'I think we would have been much more concerned about how much impact it really had on US health care.' CrowdStrike, in a statement to WIRED, strongly criticized the UCSD study and JAMA's decision to publish it, calling the paper 'junk science.' They note that the researchers didn't verify that the disrupted networks ran Windows or CrowdStrike software, and point out that Microsoft's cloud service Azure experienced a major outage on the same day, which may have been responsible for some of the hospital network disruptions. 'Drawing conclusions about downtime and patient impact without verifying the findings with any of the hospitals mentioned is completely irresponsible and scientifically indefensible,' the statement reads. 'While we reject the methodology and conclusions of this report, we recognize the impact the incident had a year ago,' the statement adds. 'As we've said from the start, we sincerely apologize to our customers and those affected and continue to focus on strengthening the resilience of our platform and the industry.' In response to CrowdStrike's criticisms, the UCSD researchers say they stand by their findings. The Azure outage that CrowdStrike noted, they point out, began the previous night and affected mostly the central US, while the outages they measured began at roughly midnight US east coast time on July 19—about the time when CrowdStrike's faulty update began crashing computers—and affected the entire country. (Microsoft did not immediately respond to a request for comment.) 'We are unaware of any other hypothesis that would explain such simultaneous geographically-distributed service outages inside hospital networks such as we see here' other than CrowdStrike's crash, writes UCSD computer science professor Stefan Savage, one of the paper's co-authors, in an email to WIRED. (JAMA declined to comment in response to CrowdStrike's criticisms.) In fact, the researchers describe their count of detected hospital disruptions as only a minimum estimate, not a measure of the real blast radius of CrowdStrike's crashes. That's in part because the researchers were only able to scan roughly a third of America's 6,000-plus hospitals, which would suggest that the true number of medical facilities affected may have been several times higher. The UCSD researchers' findings stemmed from a larger internet-scanning project they call Ransomwhere?, funded by the Advance Research Projects Agency for Health and launched in early 2024 with the intention of detecting hospitals' ransomware outages. As a result of that project, they were already probing US hospitals using the scanning tools ZMap and Censys when CrowdStrike's July 2024 calamity struck. For the 759 hospitals in which the researchers detected that a service was knocked offline on July 19, their scans also allowed them to analyze which specific services appeared to be down, using publicly available tools like Censys and the Lantern Project to identify different medical services, as well as manually checking some web-based services they could visit. They found that 202 hospitals experienced outages of services directly related to patients. Those services included staff portals used to view patient health records, fetal monitoring systems, tools for remote monitoring of patient care, secure document transfer systems that allow patients to be transferred to another hospital, 'pre-hospital' information systems like the tools that can share initial test results from an ambulance to an emergency room for patients requiring time-critical treatments, and the image storage and retrieval systems that are used to make scan results available to doctors and patients. 'If a patient was having a stroke and the radiologist needed to look at a scan image quickly, it would be much harder to get it from the CT scanner to the radiologist to read,' Dameff offers as one hypothetical example. The researchers also found that 212 hospitals had outages of 'operationally relevant' systems like staff scheduling platforms, bill payment systems, and tools for managing patient wait times. In another category of 'research relevant' services, the study found that 62 hospitals faced outages. The biggest fraction of outages in the researchers' findings was an 'other' category that included offline services that the researchers couldn't fully identify in their scans at 287 hospitals, suggesting that some of those, too, might have been uncounted patient-relevant services. 'Nothing in this paper says that someone's stroke got misdiagnosed or there was a delay in the care of someone getting life-saving antibiotics, for instance. But there might have been,' says Dameff. 'I think there's a lot of evidence of these types of disruptions. It would be hard to argue that people weren't impacted at a potentially pretty significant level.' The study's findings give a sprawling new sense of scope to anecdotal reports of how CrowdStrike's outage affected medical facilities that already surfaced over the last year. WIRED reported at the time that Baylor hospital network, a major nonprofit health care system, and Quest Diagnostics were both unable to process routine bloodwork. The Boston-area hospital system Mass General Brigham reportedly had to bring 45,000 of its PCs back online, each of which required a manual fix that took 15 to 20 minutes. In their study, researchers also tried to roughly measure the length of downtime of the hospital services affected by the CrowdStrike outage, and found that most recovered relatively quickly: About 58 percent of the hospital services were back online within six hours, and only 8 percent or so took more than 48 hours to recover. That's a far shorter disruption than the outages from actual cyberattacks that have hit hospitals, the researchers note: Mass-spreading malware attacks like NotPetya and WannaCry in 2017 as well as the Change Healthcare ransomware attack that struck the payment provider subsidiary of United Healthcare in early 2024 all shut down scores of hospitals across the US—or in the case of WannaCry, the United Kingdom—for days or weeks in some cases. But the effects of the CrowdStrike debacle nonetheless deserve to be compared to those intentionally inflicted digital disasters for hospitals, the researchers argue. 'The duration of the downtimes is different, but the breadth, the number of hospitals affected across the entire country, the scale, the potential intensity of the disruption is similar,' says Jeffrey Tully, a pediatrician, anesthesiologist, and cybersecurity researcher who coauthored the study. A map showing the duration of the apparent downtime of detected medical service outages in hospitals across the US. Courtesy of UCSD and JAMA Network Open A delay of hours, or even minutes, can increase mortality rates for heart attack and stroke patients, says Josh Corman, a cybersecurity researcher with a focus on medical cybersecurity at the Institute for Security and Technology and former CISA staffer who reviewed the UCSD study. That means that even a shorter-duration outage in patient related services across hundreds of hospitals could have concrete and seriously harmful—if hard to measure—consequences. Aside from drawing a first estimate of the possible toll on patients' health in this single incident, the UCSD team emphasizes that the real work of their study is to show that, with the right tools, it's possible to monitor and learn from these mass medical network outages. The result may be a better sense of how to prevent—or in the case of more intentional downtime from cyberattacks and ransomware—protect hospitals from experiencing them in the future.
Yahoo
2 hours ago
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The Hill
2 hours ago
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Unpasteurized vs. pasteurized: What to know about food safety
A long-practiced food processing method has been up for debate in recent years, with some opting to drink and eat without sterilizing it first. The polarizing process is pasteurization — a heating process that kills the microbes behind common foodborne illnesses. Prominent pushes for 'raw milk' consumption are growing, whether it's Health and Human Services Secretary Robert F. Kennedy Jr. or Gwyneth Paltrow. While still on the 2024 campaign trail for his failed presidential bid, Kennedy said he only drinks unpasteurized milk. In April, he suspended a quality control program for testing the nation's dairy supply. All the while, experts and researchers are advocating for Americans to only consume pasteurized milk. Pasteurized vs unpasteurized: What's the difference? Pasteurization is the process of heating a food product for a certain amount of time to destroy bacteria and viruses present, according to the Centers for Disease Control and Prevention (CDC). Dairy products, eggs, juices, canned food, flour, honey and alcohol, among others, are typically pasteurized. Unpasteurized products don't undergo the heating and germ-killing process. They can include milk, artisanal cheese, juice, meat and more. Benefits, drawbacks of pasteurization By getting rid of harmful microbes, pasteurization can prevent foodborne illnesses like listeriosis, typhoid fever, tuberculosis, diphtheria, Q fever, and brucellosis, according to the Food and Drug Administration (FDA). Pasteurization can also change the nutritional value, flavor and appearance of food, though only minimally, per the National Library of Medicine. 'Pasteurized milk offers the same nutritional benefits without the risks of raw milk consumption. Since the early 1900s, pasteurization has greatly reduced milk-borne illnesses,' the CDC says. Are unpasteurized foods safe? What are the risks? Some believe that so-called 'raw milk' and other unpasteurized products are a healthier option, since they are straight from nature. Some champion positive health returns from drinking unpasteurized milk, including raw milk farmer Cliff McConville: 'I can tell you that I used to get sick like three times a year, like, you know, with colds or flu, and I almost never get sick anymore.' But most medical bodies and independent experts say the benefits of unpasteurized food don't outweigh the potential health problems. The CDC and the FDA have warned that raw milk is unsafe because bacteria in it can cause illness or even death. The bird flu virus can remain infectious in raw milk for over a day at room temperature and more than a week when refrigerated, according to a non-peer-reviewed study from a group of UK scientists. The study, published in medRxiv, examined the stability of the H5N1 avian influenza virus in raw cow and sheep milk, with researchers simulating storage conditions common in dairy settings. 'High viral titres were detected in milk from infected cows, raising concerns about onwards human infections,' the authors wrote.
