In the 21st century, Antibiotic Resistance (AR) has become one of the biggest risks to world health. The causes, spread, and mechanism of action of AR are elucidated in this article. This article also presents 2 case studies related to AR. 

Causes and Spread of Resistance

The misuse and overuse of antibiotics in humans, livestock, and agriculture are primary drivers. Inappropriate prescriptions, incomplete courses of treatment, and unsupervised antibiotic use in low-income countries further aggravate the situation [2]. Global travel and trade also facilitate the transcontinental spread of resistant strains.

Mechanisms of Resistance

Bacteria develop resistance through various mechanisms: enzymatic degradation of drugs, alteration of drug targets, efflux pumps expelling antibiotics, and reduced permeability. These changes may arise from spontaneous mutations or horizontal gene transfer [3].

Case Study 1: NTM infection: A Myth!!!

A 27-year-old patient was started on anti-tubercular therapy based on a positive Sputum AFB (Grade 3+), despite GeneXpert being negative for M. tuberculosis. An AFB culture was advised due to suspected NTM but was delayed for months, during which the patient deteriorated. When finally performed, culture revealed Mycobacterium abscessus. Delayed diagnosis and inappropriate therapy led to antimicrobial resistance and clinical worsening. This case underscores the need for timely lab-clinician communication and strict adherence to diagnostic protocols.

Impact on Health and Economy

AR leads to prolonged hospital stays, increased medical costs, and heightened mortality. According to the OECD, resistant infections cause approximately 700,000 deaths globally each year—a number projected to rise to 10 million by 2050 if unchecked [4]. Economically, AR could cost the world over $100 trillion in lost productivity.

Projected Deaths Due to AMR by 2050

Global Response and Challenges

International efforts include the WHO’s Global Action Plan – Global AMR Surveillance System (GLASS) and national strategies like India’s National Action Plan on AMR (NAP-AMR), 2017. However, challenges remain: underfunded health systems, lack of diagnostics, and insufficient new antibiotics in the pipeline [5].

Case Study 2: Carbapenem-Resistant E. coli (CRE) in a Community Setting

A 64-year-old woman in a tier-II city presents with recurrent urinary tract infections. Cultures reveal Carbapenem-resistant E. coli, resistant to most drugs, even fosfomycin and nitrofurantoin, commonly used in UTIS. Community-acquired infections like this are becoming more common, complicating outpatient treatments and burdening healthcare systems.

However, with the availability of detection of carbapenemase resistant marker genes – KPC, NDM, IPM, VIM and OXA-48, nowadays newer targeted agents such as Ceftazidime-Avibactam ± Aztreonam, Cefepime-Zidebactam, Meropenem-Vaborbactam, Meropenem-nacubactam, Imipenem-relebactam, Tigecycline, Plazomicin, or Cefiderocol can be used as targeted therapy.

Role of Healthcare Professionals

Clinicians, microbiologists, and pharmacists play a pivotal role in antibiotic stewardship. Rational prescribing, use of rapid diagnostics, and continuous education can curb unnecessary antibiotic usage. Campaigns to raise public awareness are equally important [8].

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Anirudh Gupta is a Senior Consultant Microbiologist from New Delhi.