Drug-resistant pathogens responsible for sepsis, ventilator-associated pneumonia, complicated urinary tract infections, and multidrug-resistant tuberculosis have emerged as some of Pakistan’s most serious public health threats, federal health officials have warned.
Authorities say antimicrobial resistance (AMR) in priority bacterial and fungal pathogens could claim more than 262,000 lives in Pakistan over the next 25 years if antibiotic misuse and infection control failures are not urgently addressed.
Pakistan has become the first country in the World Health Organization Eastern Mediterranean Region to compile a national Priority Pathogen List. The document is designed to guide hospitals, laboratories, and policymakers on strengthening surveillance, infection prevention, and rational antibiotic use.
A senior official at the National Institutes of Health in Islamabad said the list identifies the most dangerous bacteria and fungi threatening public health.
Several hospital-associated bacteria have been placed in the “critical” category, including:
These organisms are frequently linked to life-threatening bloodstream infections, ventilator-associated pneumonia, and complex urinary infections in intensive care units. Officials say resistance to multiple antibiotics has made such infections harder to treat and increased mortality risks among critically ill patients.
Drug-resistant tuberculosis also ranks among the most critical threats, underscoring Pakistan’s ongoing struggle with multidrug-resistant TB, which requires prolonged and costly treatment.
Other critical pathogens include Enterococcus faecium and Staphylococcus aureus, both major causes of bloodstream and wound infections in hospitalized patients.
High-priority pathogens include:
These bacteria are responsible for food- and waterborne diseases and sexually transmitted infections, with rising resistance limiting treatment options.
Medium-priority organisms include:
These remain significant causes of pneumonia, meningitis, and cholera outbreaks.
The list also highlights fungal threats such as Candida species, including drug-resistant Candida auris, as well as Aspergillus, Cryptococcus, and Pneumocystis jirovecii. Mucorales fungi, which cause mucormycosis, have also been included due to their severe impact on patients with uncontrolled diabetes.
Industry data indicate that Pakistan’s pharmaceutical sector surpassed Rs1.049 trillion in retail sales in the year ending March 2025, with antibiotics accounting for approximately Rs185 billion of the total market.
Figures from the Drug Regulatory Authority of Pakistan show that around Rs126 billion worth of antibiotics were used in 2023 alone, with a significant proportion dispensed without prescriptions. Experts warn that widespread misuse, particularly of broad-spectrum “Watch” category antibiotics, is accelerating resistance.
Studies suggest that more than 70 per cent of antibiotic prescriptions fall into high-risk categories of overuse.
Health experts caution that rising antimicrobial resistance could make routine medical procedures such as surgery, childbirth, and cancer treatment significantly riskier if effective antibiotics become scarce.
Officials say the Priority Pathogen List will support improved surveillance, laboratory investment, and antibiotic stewardship under Pakistan’s National Action Plan on Antimicrobial Resistance 2024–2029.
They have called for stricter enforcement of prescription laws, tighter regulation of antibiotic sales, improved diagnostic capacity, and stronger infection prevention measures in hospitals and clinics to prevent a looming public health crisis.