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Published in the Tagesspiegel Background

By Peter Beyer, Deputy Executive Director, the Global Antibiotic Research & Development Partnership (GARDP) 

Sepsis is often described as a race against time. Every hour that passes before treatment increases the risk of organ failure and death. That is why in Germany, where more people die from sepsis compared with other high-income countries, like the US, Australia and the UK, public health campaigns have rightly focused on a single question: how can we recognise it sooner? 

Yet what is often missing from the discussion is that sepsis itself is becoming harder to treat because of antibiotic resistance. Some of the Gram-negative bacteria responsible for the most severe cases of sepsis are evolving resistance faster than new antibiotics are being developed. Winning the race against time only matters if there is still an effective treatment waiting at the finish line. 

Sepsis occurs when an infection triggers an inflammatory response, which if left untreated can quickly become life-threatening. Globally it is one of the biggest killers, and responsible for more than one fifth of all deaths. In Germany, where every year there are around 230,000 sepsis cases, of which more than 85,000 result in death, efforts to improve awareness and diagnosis are helping more patients receive treatment sooner. But increasingly those treatments are failing. 

The problem is particularly acute for some of the most difficult-to-treat Gram-negative bacteria that frequently cause severe bloodstream infections and sepsis, including Klebsiella pneumoniae, Escherichia coli and Acinetobacter baumannii. These pathogens are increasingly resistant to multiple antibiotics, leaving clinicians with fewer and fewer treatment options. In some cases, the antibiotics that once reliably cured infections are no longer effective. For patients with sepsis, that can mean the difference between recovery and a rapidly deteriorating condition. 

Worryingly, this is a trend that is likely to get worse. Antibiotic resistance is not just on the rise globally but is now believed to have reached a tipping point. With fewer antibiotics being developed, effective new drugs are not being made available to replace those lost to resistance. This is particularly the case for those that target the World Health Organization (WHO) priority pathogens, multidrug-resistant bacteria that pose the greatest public health threat. As a result, drug-resistant infections are now beginning to outpace antibiotic development. With the most difficult-to-treat Gram-negative infections expected to make up an increasing proportion of resistant infections, the number of associated deaths is forecast to rise sharply, increasing by 70% by 2050. 

Germany is not immune from this trend. Like many countries, it faces growing resistance among key pathogens and a pipeline of new antibiotics that remains dangerously thin. What’s more, with a growing population of older people and those living with chronic health conditions, more people in Germany will be at a high risk of sepsis. Yet, despite the remarkable progress of national campaigns like Deutschland Erkennt Sepsis in helping to improve sepsis awareness, and helping more people receive treatment sooner, the rise and spread of antibiotic resistance and the threat it poses remains largely absent from the conversation. The result is an increasingly fragile safety net beneath modern medicine. 

If we are serious about reducing sepsis mortality, we must recognise that the effectiveness of treatment is just as important as the speed with which it is delivered. That means investing not only in diagnostic tools, awareness campaigns and better clinical pathways, but also in the research and development of new antibiotics. 

However, there are reasons for optimism. Through public-private partnerships such as the Global Antibiotic Research & Development Partnership (GARDP), new treatments are being developed for the multidrug-resistant pathogens that cause sepsis. Germany has been a longstanding supporter of these efforts, helping to drive the development of urgently needed antibiotics while promoting responsible access and stewardship. But much more investment and political commitment will be needed if innovation is to keep pace with resistance. 

On Sunday, the theme for this year’s World Sepsis Day is “Invest in sepsis – save lives”. This is an important call to action, but it can only hold true if effective treatments remain available. So, investing in sepsis must mean more than improving awareness and diagnosis. It must also mean investing in the development of new and effective antibiotics. Without them, even the best diagnostics, the fastest response times and the most advanced healthcare systems will struggle to save lives. 

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Antimicrobial Resistance (AMR) and neonatal health crises have escalated into critical public health emergencies across Bangladesh, threatening national healthcare infrastructure and standard of living. Driven by the unregulated use of antibiotics, severe diagnostic bottlenecks, poor hospital hygiene, and environmental contamination, multidrug-resistant superbugs are now primary contributors to rising child mortality.

Evaluating sepsis risk scores in paediatric care

Paediatric sepsis remains a leading cause of child mortality across Bangladesh. A separate observational study focused on children admitted with active sepsis to a tertiary hospital in Dhaka revealed an in-hospital mortality rate of approximately 23%. Although this research focused on older paediatric cohorts (aged two months to 18 years), evaluating international organ dysfunction scoring systems like PELOD-2, pSOFA, and the Phoenix Sepsis Score provides vital insights into optimising early critical care management, which can systematically inform and strengthen risk stratification frameworks for vulnerable newborns. The results demonstrated that all three scoring methods had high predictive accuracy. Among them, pSOFA and PELOD-2 provided the most precise discrimination of mortality risk, yielding Area Under the Curve (AUC) values of 0.83 and 0.82, respectively. 

The write-up is a part of Without Borders Media Fellowship by MSF-GARDP Grant on Antimicrobial Resistance, which encourages independent, impartial, and neutral reporting on health and humanitarian crises. 

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Sepsis, a severe bloodstream infection, has evolved into a major public health threat. When coupled with Antimicrobial Resistance (AMR), it directly imperils the future of newborns in Bangladesh. The first 28 days of life constitute an exceptionally fragile window. A bacterial infection invading the bloodstream during this period is clinically defined as neonatal sepsis. This condition stands as a major global health crisis. Annually, over 10 million newborns develop this infection worldwide, resulting in approximately 200,000 to 250,000 deaths.

The situation in Bangladesh is uniquely alarming. Nearly 18,000 newborns die from infections here each year. While neonatal sepsis is multifactorial—driven by complex clinical, environmental, and socioeconomic vulnerabilities—AMR significantly complicates treatment and causes a high number of fatalities. Recognising the symptoms of sepsis remains inherently challenging. An infected infant typically feeds less than usual, exhibits severe lethargy, experiences rapid breathing, and suffers from an abnormally high or low body temperature. Because these clinical presentations mimic common, benign illnesses, diagnostic delays are frequent.

The write-up is a part of Without Borders Media Fellowship by MSF-GARDP Grant on Antimicrobial Resistance, which encourages independent, impartial, and neutral reporting on health and humanitarian crises. 

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Antimicrobial Resistance (AMR) stands as one of the greatest threats to human health and the progress of modern medicine today. According to the World Health Organization (WHO), it ranks among the top 10 global public health threats, pushing healthcare systems towards growing uncertainty. Recent global statistics indicate that between 2020 and 2021, approximately 1.2 million people died annually as a direct result of drug-resistant pathogens, while the indirect death toll reached nearly 4.8 million. Experts warn that without effective preventive measures at both global and national levels, AMR could claim 10 million lives annually by 2050. This means that roughly every three minutes, someone could die from a common infection that cannot be treated with any currently available medication.

The write-up is a part of Without Borders Media Fellowship by MSF-GARDP Grant on Antimicrobial Resistance, which encourages independent, impartial, and neutral reporting on health and humanitarian crises. 

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Published in the STAT

By Peter Beyer, Deputy Executive Director, the Global Antibiotic Research & Development Partnership (GARDP) 

In the climate debate, low- and middle-income countries have often been blamed for rising emissions, while the vastly greater historical contribution of wealthy nations is treated as yesterday’s story.

Something similar has happened with the global antimicrobial resistance (AMR) crisis. Low- and middle-income countries (LMICs) have long been portrayed as the worst offenders of antibiotic overuse, with over-the-counter sales and weak regulation seen as one of the main reasons behind the rise and spread of drug-resistant infections. But a new study now challenges this narrative.

Research published in the Lancet Public Health found that overuse is actually concentrated in high-income settings, with these countries consuming the largest volumes of antibiotics used to treat drug-resistant infections. In contrast, many lower-income countries still lack access to these drugs, despite accounting for more than 80% of the estimated global need.

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