What it will take to outrun antimicrobial resistance
Healthcare organizations will need to prioritize surveillance, stewardship and innovation in their systems solutions.
The contours of antimicrobial resistance are clear. Mortality is rising, inequities are widening and the operational burden on health systems continues to grow. The more difficult question is what it will actually take to outpace resistance.
The uncomfortable answer is that there is no single lever. Antimicrobial resistance (AMR) is a systems problem, which means the response must be a systems strategy. That strategy rests on three reinforcing pillars – surveillance that detects earlier, stewardship that scales reliably and innovation that reopens the therapeutic pipeline.
Health systems that continue to treat AMR as a periodic infection control initiative will remain in a defensive posture. Systems that treat AMR as a data-driven, governance-backed operating discipline are best positioned to bend the curve.
You can’t manage what you can’t see
Surveillance is the backbone of any credible AMR strategy. Yet in many regions, surveillance remains fragmented, constrained by limited laboratory capacity, inconsistent reporting standards, and weak integration between clinical care and public health systems. The result is a dangerous lag in visibility, where resistance trends become apparent only after they are clinically disruptive.
The World Health Organization’s Global Antimicrobial Resistance Surveillance System (GLASS) was designed to standardize how countries collect and report AMR data, enabling cross-border visibility and coordinated response. At the national level, the CDC’s National Healthcare Safety Network (NHSN) provides a structured foundation for tracking healthcare-associated infections and resistance trends.
For healthcare leaders, participation in surveillance is not sufficient. Surveillance must be modernized to become actionable. That means supporting early detection of resistance trends; targeted, risk-based response; and informed investment in prevention and control.
One of the most consequential upgrades is the integration of genomic tools. Whole-genome sequencing enables precise tracking of resistant organisms and transmission pathways. Research has demonstrated its value for predicting drug susceptibility and resistance, including work in The Lancet Infectious Diseases on WGS for the prediction of tuberculosis drug susceptibility.
Genomic surveillance enables systems to distinguish between sporadic cases and clustered transmission. That distinction is critical when resources are constrained, and outbreaks move quickly.
Equally important is the integration of surveillance across domains. AMR does not reside exclusively in hospitals. It moves through communities, agriculture, pharmaceutical manufacturing, wastewater and the food supply chain. Surveillance that ignores these pathways will remain reactive by design.
Making the right antibiotic the default
Surveillance alone does not change outcomes if prescribing behavior and operational controls remain inconsistent. That is the role of antimicrobial stewardship.
As a foundation, stewardship defines the discipline, optimizing antibiotic use to improve outcomes, reduce unnecessary exposure and limit resistance pressure. The framing is well established and clearly defines what is antimicrobial stewardship is. But effectiveness depends on more than definitions. It depends on execution.
Evidence supports stewardship’s impact. A systematic review and meta-analysis in The Lancet Infectious Diseases found that stewardship interventions reduce infections and colonization with resistant organisms and Clostridioides difficile (stewardship impact meta-analysis). The challenge lies in translating this evidence into workflows that function under real-world constraints such as time pressure, diagnostic uncertainty, variation in clinical culture and competing operational priorities.
This is where health data and digital infrastructure become decisive. Stewardship cannot function as a periodic committee activity. It must be embedded directly into clinical workflows, particularly through electronic health records and decision support systems.
Clinical frameworks such as the “Four Moments” of antibiotic decision-making provide a conceptual structure. To drive consistent adoption, those moments must be operationalized through systems that support clinicians at the point of care.
In practice, scalable stewardship requires:
The most effective stewardship models are not educational add-ons. They are designed systems, aligned with workflow, supported by governance and continuously measured.
Rebuilding a pipeline that has slowed
Surveillance and stewardship reduce resistance pressure, but they do not resolve the pipeline problem. Resistant organisms continue to evolve. Without innovation, the therapeutic toolkit eventually falls behind.
The antibiotic development pipeline has slowed dramatically, constrained by economic disincentives and regulatory complexity. Multiple analyses have documented these challenges, including research examining incentive strategies for discovery and development of novel antibiotics.
Therefore, innovation must extend beyond traditional antibiotics. Several pathways are increasingly relevant:
Bacteriophage therapy is one example — using viruses to target specific bacteria. The promise and trajectory are explored in an editorial in Frontiers in Microbiology on phage therapy: past, present and future.
Antimicrobial peptides and other non-traditional approaches are another important pathway, including the assessment of their value in the age of resistance in The Lancet Infectious Diseases (antimicrobial peptides).
AI-enabled drug discovery is also emerging as a serious accelerator. A landmark study in Cell demonstrated the potential of deep learning to identify novel antimicrobial compounds (a deep learning approach to antibiotic discovery). The key relevance here is time. AI can reduce the search space and speed early-stage discovery, helping address the long timelines that have historically made antibiotic development economically unattractive.
Innovation also requires funding models that reflect AMR’s public-good dynamics. The paper notes the role of initiatives such as CARB-X and the broader need to close the research funding gap — an issue reinforced by work on alternatives and pipeline strategies in The Lancet Infectious Diseases (alternatives to antibiotics portfolio review).
Policy, coordination and the One Health imperative
AMR is transnational, cross-sector, and amplified by trade and travel. Which means no institution can “opt out” of the risk.
The WHO’s Global action plan on antimicrobial resistance provides a coordinated blueprint, but execution depends on national action plans with real accountability and funding. Globally, the One Health framing remains essential — AMR emerges from the combined dynamics of human medicine, agriculture and the environment, as argued in work that describes AMR as the quintessential One Health issue.
Agricultural policy is a prime example. Evidence shows that restricting antibiotic use in food-producing animals is associated with reduced resistance, as demonstrated in The Lancet Planetary Health (restriction and resistance meta-analysis). This is not a “nice to have” policy reform. It is part of the resistance pressure equation.
Practical takeaway for health data leaders
The path forward is not mysterious, but it is demanding. Health systems that want to stay ahead of AMR must treat it as a measurable operational risk.
That requires building surveillance infrastructure capable of earlier detection, including genomics; stewardship models embedded into workflows and governed with accountability; and innovation partnerships and policy alignment that expand therapeutic options.
A single breakthrough will not solve AMR. It will be managed in the same way as safety, quality and cybersecurity – through disciplined systems that make the right actions easier to take, more consistent and measurable over time.
The systems that invest in this infrastructure now will be the ones still capable of delivering safe, effective care as resistance continues to rise.
Dr. Julia Rehman FACHE, FACHDM, is vice president – Middle East & North Africa (MENA) at the American College of Healthcare Executives and is the founder and chief operating officer of Kota Kompany.