UKHSA recorded 20,484 antibiotic-resistant bloodstream infections in England in 2024. WHO's global pipeline review found 90 antibacterial drugs in development worldwide — but only a handful target the bacteria it ranks most dangerous, and just four reached the market since the last count.
The UK Health Security Agency's ESPAUR surveillance programme recorded 20,484 antibiotic-resistant bloodstream infections (bacteraemia) in England in 2024, up 9.3% on 2023 and 13.1% above the 2019 pre-pandemic baseline.1 E. coli and Klebsiella pneumoniae drove most of the rise; together, Enterobacterales — the family that includes both — accounted for 85.1% of the resistant burden.1
The clearest single measure of that drift is resistance to third-generation cephalosporins in E. coli bacteraemia — a front-line hospital antibiotic class. It has risen every year since 2021, from 13.5% of isolates to 16.9% in 2024.1 The burden also falls unevenly: resistant bacteraemia rates are 47% higher in England's most deprived areas than its least deprived, a gap that has widened by 18% since 2019.1
WHO's most recent global pipeline review counted 90 antibacterial agents in clinical development worldwide as of February 2025, down from 97 at the end of 2023.2 That headline number understates the problem: WHO judges only 15 of the 90 to be genuinely innovative (a new drug class, target or mechanism, with no known cross-resistance), and just 5 are active against a pathogen on its "critical" priority list — the group that includes carbapenem-resistant Enterobacterales, the class driving much of England's rise.2 Since the 2023 count, 4 agents have won regulatory approval anywhere in the world, 1 is under review, and 10 have been withdrawn from development.2
Researchers attribute the gap between candidates and approvals mainly to economics rather than science: antibiotics are typically used briefly and kept off the shelf as a last resort, so returns on a successful launch are low relative to development cost, and several large manufacturers — including Novartis, Sanofi and AstraZeneca — have exited antibacterial research and development entirely since 2018.3 This is the field's own diagnosis of the market, not an independently verified causal study, so it is presented here as analysis, not settled fact.
UKHSA's "AMR burden" figure counts bloodstream infections resistant to at least one critical antibiotic in a defined pathogen panel; it is a surveillance measure, not a full census of resistant infection in England, and case ascertainment against parallel voluntary schemes ran at 91% in 2024. WHO's pipeline count is a snapshot of what companies have disclosed as in development; it cannot say how many of the 90 candidates will ultimately reach approval, or how many will hold up against resistance by the time they do. UKHSA modelling puts roughly one in ten deaths following a resistant bacteraemia as directly attributable to the resistance itself, rather than the underlying illness — the rest reflects patients who were already more vulnerable, a distinction the headline totals do not capture.
Left out to hold this to a short read: