Drug-resistant bacteria are no longer confined to hospital settings but are spreading into communities across every country, warns Peter Beyer, deputy executive director of the Global Antibiotic Research & Development Partnership (GARDP). Writing in response to a spike in sexually transmitted infections (STIs) in Europe, Beyer argues that the trend is a warning sign for the global spread of antimicrobial resistance (AMR).
Unprecedented spike in drug-resistant gonorrhoea
According to Beyer, there were 82 million new cases of gonorrhoea globally in 2020, the majority in low- and middle-income countries (LMICs). A growing number of these infections are becoming more difficult—and in some cases almost impossible—to treat as AMR erodes the effectiveness of antibiotics. Extensively drug-resistant strains detected in Cambodia have spread as far as France and Australia.
Neisseria gonorrhoeae has developed resistance to most antibiotics, leaving only one last recommended drug, ceftriaxone. With cases resistant even to this on the rise, gonorrhoea risks becoming one of the first diseases to be no longer treatable.
Broader shift beyond hospitals
Beyer emphasises that drug resistance is often framed as a hospital problem, but bacteria move with people across cities, borders, and continents. They can be carried by infected individuals or unwittingly colonised hosts. A gene conferring resistance to last-resort antibiotics was identified in the 1990s and spread worldwide within a decade.
Community-acquired drug-resistant infections such as methicillin-resistant Staphylococcus aureus (MRSA) are becoming more common, particularly among vulnerable groups like cancer patients. In LMICs, where outpatient care is prevalent and infection control resources limited, risks amplify. Large studies report high rates of drug-resistant infections among cancer outpatients, with pneumonia occurring frequently and carrying significant mortality risk.
Need for new antibiotics and a new model
Beyer notes that one in six bacterial infections is now resistant to first-line antibiotics, and resistance is outpacing antibiotic development. The traditional commercial model for R&D prioritises profitability, failing to deliver antibiotics most needed for LMICs.
A new model is exemplified by zoliflodacin, a first-in-class antibiotic for multidrug-resistant gonorrhoea developed through a not-for-profit partnership led by GARDP. Beyer states: "The development of zoliflodacin shows that the antibiotics we need can be created as global public health goods—prioritising access, stewardship, and sustainable use across all countries, rather than profit margin."
AMR at a tipping point
There are nearly 5 million AMR-related deaths each year, expected to rise by 70% by 2050. Beyer concludes: "As drug-resistant infections take hold in the community, the boundary between everyday life and high-risk settings is disappearing. Ordinary interactions—at home, at work, in public—are becoming pathways for infections that are increasingly hard to treat. Unless we act, we risk a future in which common infections can no longer be reliably treated, and where the consequences are felt far beyond hospital walls."
