The study analyzed previous peer-reviewed research that addresses pre-formulated research questions using a literature review approach. This method allows for an efficient and comprehensive synthesis of the body of existing literature by offering an in-depth overview of the state of knowledge on the subject today. This approach made it possible to identify knowledge gaps, extract important insights, and formulate well-informed judgments. The Electronic Databases (EDs) that are specifically used for this purpose are those offered by well-known publishers such as PubMed, Google Scholar, ScienceDirect, and Scopus. We executed a comprehensive search in all database fields by using the following terms (Sustainable Development Goals OR SDG’S), (Agenda 2030), (AMR and SDG’s) and (Health and Agenda 2030).

This search approach was established to identify relevant studies that addressed the relationship between AMRs and SDG's. The mentioned databases were selected due to their broad coverage of academic literature in many domains, guaranteeing access to a diversified range of peer-reviewed papers, journals, and research publications that are crucial for carrying out an exhaustive evaluation. We carefully analyze articles referencing the Sustainable Development Goals and AMR, ensuring they directly address the research topic. This rigorous approach not only ensured relevance and coherence but also made sure to stick to the problem statement in our review and enhance the quality and precision of our findings.

Antimicrobial resistance (AMR): a pressing global health crisis

Naturally occurring compounds known as antimicrobials play a crucial role in either killing or inhibiting the growth of microorganisms. Their significance in human medicine is profound, as they have significantly improved medical practices such as surgeries and the treatment of infections. Beyond human health, antimicrobials also play a vital role in supporting the economic well-being of millions of farmers and livestock keepers globally. They contribute to the health of animals, enhance agricultural productivity, and ensure food safety. The availability and effectiveness of antimicrobials have increased, leading to improvements in agricultural productivity, overall food safety, and animal welfare [75]. However, this widespread use of antimicrobials has introduced challenges, particularly in the form of antimicrobial resistance (AMR).

AMR existed in nature before humans began using antimicrobial agents, and its development is driven by natural selection. Resistant microorganisms thrive in environments exposed to antimicrobials. Enzyme activity plays a significant role in many forms of AMR, as resistant bacteria transfer genes to the next generation. Some bacteria employ methods for intergenerational genetic exchange, complicating the dynamics of the AMR process [14]. The intricate relationship between antimicrobials, resistance, and microbial dynamics underscores the importance of responsible and judicious use to ensure their continued efficacy.

Antimicrobial resistance (AMR) is experiencing a sharp rise, exacerbated by the obsolescence of many standard antibiotic treatment regimens (Fig. 1). This trend poses the risk of patients in critical conditions requiring palliative care, yet the prescribed drugs are no longer clinically effective [4]. Antibiotic-resistant bacteria employ various strategies, including enzyme degradation, enzymatic scaffold modifications, efflux pumps, alterations to targets, adjustments to cell membrane permeability, and changes in the expression of the intended target. Some bacteria limit membrane or wall permeability to prevent antibiotics from entering the cell, while others create variations of selective prions that inhibit prion expression [43]. The multifaceted mechanisms of antibiotic resistance underscore the urgent need for comprehensive strategies to address this global health challenge.

Fig. 1

Development of antibiotic resistance overtime

The Centers for Disease Control and Prevention's 2019 antibiotic resistance danger assessment reveals alarming statistics, with over 2.8 million cases of Antimicrobial Resistance (AMR), resulting in over 35,000 fatalities annually in the United States. The study categorizes carbapenem resistance as urgent, emphasizing the severity of the issue. The assessment further classifies risks into categories such as serious, urgent, worrying, and watch list. Of particular concern is the emergence of carbapenem-resistant bacteria, as these are considered "last-resort" medications for treating multidrug-resistant illnesses. The rise of such resistance poses a significant threat to public health. The assessment by Jim O'Neill underscores the profound impact of antimicrobial resistance, highlighting it as a major contributor to the global burden of illness [67] (Fig. 2). Addressing the challenges posed by AMR requires concerted efforts and innovative solutions to ensure the continued efficacy of antibiotics and safeguard public health.

Fig. 2

Estimated death count by different diseases till 2050

As the crisis of Antimicrobial Resistance (AMR) reaches its zenith, experts are warning that the era of having no effective antibiotics is fast approaching [93]. Collaborative research is under consideration to discover new antibiotic combinations that can overcome resistance and enhance the effectiveness of last-resort medications [65]. The pace of new antibiotic research and development has significantly slowed since the late 1990s, with only three new antibiotics approved by the FDA in the past 30 years [90]. Recent WHO studies on clinical and preclinical drug development highlight a limited pipeline for antibiotic drugs, raising concerns about the global efforts to control drug-resistant diseases. Among the 50 antibiotics undergoing clinical trials, most offer modest advantages, and of those in preclinical development, 252 are still in the early stages of research [104]. This scarcity of new and potent antibiotics poses a serious threat to our ability to combat drug-resistant infections and underscores the urgency for increased research and development in this critical area of medicine.

From household to economy: socio-economic ramifications of AMR

Antimicrobial Resistance (AMR) imposes substantial clinical and economic burdens on healthcare systems and patients. In the United States, the annual cost of AMR amounts to $55 billion, with $20 billion spent on healthcare and an additional $35 billion lost due to decreased productivity [2]. World Bank research suggests that the impact of AMR may be more pronounced in low-income nations, potentially exacerbating poverty rates. By 2050, there could be a 1% decline in global GDP, with poorer nations experiencing a 5–7% drop, leading to losses ranging from $100 to $210 trillion. By 2007, drug-resistant tuberculosis alone was estimated to cost the world $16.7 trillion. AMR further amplifies global inequality by widening the gap between wealthy and poor nations, with impoverished populations being the most severely affected due to the high incidence of infectious diseases. Moreover, AMR has implications for workforce productivity, reducing it due to illness and premature mortality [45]. The ongoing COVID-19 pandemic adds an additional layer of complexity to the global economy by adding more expenditures in context to antibiotics usage. A review indicates that 72% of 2,010 COVID-19 patients received broad-spectrum antimicrobial therapy, even though only 8% experienced bacterial and fungal co-infection. The World Health Organization (WHO) discourages the inappropriate use of antibiotics, especially among mild COVID-19 patients [74]. The intertwined challenges of AMR and the COVID-19 pandemic underscore the critical need for judicious use of antimicrobials and global collaborative efforts to address these complex health issues.

Antimicrobial resistance (AMR) has far-reaching consequences that extend to the workforce, significantly impacting population size and the quality of human capital. Researchers have developed a theoretical model to project the economic effects of AMR on the workforce in the future. Comparing a non-AMR baseline with current trends and potentially worse alternatives, their findings suggest that without intervention, the world's working-age population could decline by two years within a decade, with Eurasia experiencing the most significant impact [22]. If the trends of AMR continue unabated, the global economy could face an annual GDP loss of approximately $28 billion over the next ten years. In this scenario, the European Union and Organization for Economic Cooperation and Development (OECD) countries would bear a significant portion of the loss, with a $20 billion reduction in GDP [92]. The impact of AMR is particularly pronounced in developing countries, where high infectious disease cases and a reliance on labor income contribute to elevated healthcare expenditures. Challenges such as poor implementation, lack of regulation enforcement, low antibiotic awareness, and inadequate distribution of treatment recommendations make effective therapy challenging to obtain in these nations, especially in low- and middle-income countries [9, 15]. Addressing AMR is not only a healthcare imperative but also a critical component of sustaining global economic health and workforce productivity.

Decoding AMR: unraveling the primary contributing factors

Addressing the complex nature of Antimicrobial Resistance (AMR) and implementing comprehensive strategies to mitigate its impact requires a thorough understanding of the primary contributing factors (Fig. 3). The rapid development of Antimicrobial Resistance (AMR) is largely attributed to the overuse and misuse of currently available antimicrobials. Global antibiotic usage increased by 65% between 2000 and 2015 [50]. The improper use of antibiotics is prevalent in both general and acute care settings, particularly among healthcare providers working with infants and young patients. In South Africa, up to 55% of primary care physicians misuse antibiotics, while the figures are 88% in Pakistan, 61% in China, and 15.4% in Canada. The reliance on prescription medication, especially antibiotics, for patient care is widespread in developing nations due to a lack of adequate diagnostic tools. Another common form of antibiotic misuse is administering them when they are not truly needed for therapy [22]. In Louisiana, up to 60% of antibiotic prescriptions were written for inappropriate purposes [14]. The abuse and overuse of antibiotics significantly increase the likelihood of the emergence of AMR, particularly among bacteria classified as WHO priority pathogens [101] (Fig. 4). Addressing these practices is crucial to curbing the escalation of AMR and preserving the effectiveness of existing antimicrobials.

Fig. 3

Antimicrobial resistance contributing factor

Fig. 4

Priority pathogen list by WHO for developing new antibiotics

During the COVID-19 pandemic, a rise in antibiotic prescriptions for prophylaxis has been observed in treatment plans, contributing to an increase in antimicrobial resistance (AMR) pathogens [47]. Another significant factor in the increasing AMR ratio is the extensive use of antibiotics in agriculture for disease prevention; in the US, 80 percent of all antibiotic sales are dedicated to treating animal feed. In 2010, 63,200 tons of antibiotics were used in cattle production, surpassing the quantity used for human consumption [21]. Antibiotics are administered to drinking water and nutritious animal feed to keep animals healthy, increase herd size, and enhance feed efficiency. Colistin, a crucial last-line antibiotic for treating serious infections in humans, is frequently used in animal husbandry [53]. While the European Union (EU) banned the use of antibiotics for growth promotion in 2003 [70], the FDA made it illegal to provide antibiotics to cattle without a veterinarian's prescription in 2012 [91]. Despite these measures, 26 out of 160 countries still used antibiotics as growth enhancers in agriculture in 2019 [31]. The modern and easily accessible travel routes have played a significant role in the global spread of antimicrobial resistance. Travelers may be exposed to resistant pathogens, increasing the likelihood of returning colonized and infected individuals [27].). For instance, European tourists to India, with no contact with the Indian healthcare system, tested positive for carbapenemase-producing Enterobacteriaceae (CPE) after returning from their trip indicates potential acquisition of bacteria during the trip. The overuse of antibiotics in developing nations, often associated with growing income linked to GDP growth and improvements in living standards in low- and middle-income countries, is a major driver of the global rise in antibiotic usage [79]. Addressing antibiotic use in both healthcare and agriculture is crucial to combat the growing threat of antimicrobial resistance.

As developing countries experience economic growth, their dietary patterns shift towards higher consumption of animal protein, increasing demand for livestock production. This intensification frequently involves packed and unsanitary conditions, increasing the risk of disease propagation among animals, leading to more antibiotic use to maintain production levels and prevent outbreaks [98]. Over the past decade, there has been a global shift in antibacterial use patterns, with low- and middle-income countries (LMICs), including Turkey, Tunisia, Algeria, and Romania, having the highest rates in 2015. It is expected that, in the coming years despite LMICs currently having lower rates of antibiotic use as compared to first world countries, these rates will eventually surpass or even converge with those of high-income nations [50]. Bacterial evolution and mutation can lead to spontaneous antibiotic resistance, with insertion sequences and transposons providing plasmids access to resistance genes [81]. The transfer of these plasmids can spread antibiotic resistance to other species [89]. Currently, only 42 nations collect comprehensive data on antibiotic usage in healthcare and animal husbandry, contributing to the ongoing trends of AMR [102]. Additionally, there is a significant lack of knowledge among individuals regarding the appropriate usage and potential risks associated with antibiotics, as indicated by national questionnaires in various developed and developing nations, including the US, Sri Lanka, Japan, Australia, and the Gulf Cooperation Council. This lack of awareness serves as a vital contributing factor to AMR [27]. Addressing antimicrobial resistance requires a comprehensive, interdisciplinary strategy involving the medical, agricultural, and environmental sectors. By adopting this approach, stakeholders can develop long-lasting solutions to ensure the effectiveness of our antibacterial arsenal for future generations.

Strengthening healthcare: approaches to addressing AMR

Antimicrobial resistance (AMR) is indeed a significant global health concern, and its implications extend to the achievement of SDGs. According to current estimates, 1.27 million deaths worldwide in 2019 were directly linked to AMR, with an additional 4.95 million deaths indirectly associated with infections related to AMR [64]. To Recognizing the severity of the issue, the World Health Organization (WHO) declared AMR a major global concern in 2014. In response, the World Health Assembly released the Global Action Plan on Antimicrobial Resistance, urging member nations to implement comparable strategies by May 2017 [103]. Measures such as the judicious use of antimicrobial drugs have been employed to reduce the prevalence and transmission of AMR. The Food and Drug Administration (FDA) in the United States has also implemented steps to assess AMR outbreaks [41]. Rapid diagnostic testing is crucial in the fight against AMR, especially in developing countries where standard microbiological methods may be insufficient. New genetic screening technologies can be utilized to generate personalized medicines for appropriate antimicrobial therapy. The One-Health concept, exploring human-animal interactions and proposing novel evaluation techniques, is considered instrumental in addressing AMR [19]. Global initiatives, such as the declaration of the 2016 high-level meeting on antimicrobial resistance at the United Nations General Assembly and the FAO/OIE/WHO Tripartite Collaboration, represent national and international efforts to combat the spread of AMR. In 2022, the Tripartite Collaboration expanded to include UNEP, forming the Quadripartite, which also involves the World Organization for Animal Health (WOAH). The Quadripartite collaborates to highlight the potential harm caused by AMR to humans, animals, plants, ecosystems, and livelihoods [68].

Antimicrobial resistance (AMR) has been a global concern for several decades, dating back to Sir Alexander Fleming's warning in the 1940s [78]. The concept of "antimicrobial stewardship" (AMS) was introduced by McGowan and Gerding in 1996 and later adopted by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) [61, 39]. AMS is defined as an organizational or healthcare-system-wide approach aimed at fostering and monitoring the judicious use of antimicrobials to preserve their effectiveness [28]. In Europe, national programs were established to raise awareness and ensure prudent antibiotic use, and in 2016, the World Health Organization (WHO) and the United Nations (UN) endorsed the implementation of stewardship programs, emphasizing the importance of adapting strategies to local contexts [105]. The Food and Agriculture Organization (FAO) of the UN outlines four essential pillars to promote and support AMS at the national and international levels [32] (Fig. 5). These pillars likely encompass various aspects of awareness, education, monitoring, and enforcement to ensure responsible antimicrobial use. Highlighting the impact of AMS, the University of Maryland Stewardship Program demonstrated significant cost savings ranging from $200,000 to $900,000 per year. Over three years, the program reduced antibiotic spending by $3 million. Notably, after discontinuation, spending on antibiotics increased by $2 million [87]. AMS programs not only contribute to economic efficiency but also promote responsible resource use in healthcare. Additionally, they facilitate cross-border collaboration, recognizing that AMR is a global issue that requires international cooperation. The success of these programs underscores the importance of coordinated efforts to address AMR at various levels.

Fig. 5

Key elements of antimicrobial stewardship

To address the challenge of antimicrobial resistance (AMR), there is a need for a collaborative global effort that accelerates scientific discovery and integrates solutions into existing systems. The proposal suggests establishing a worldwide network-to-network (NTN) collaboration, which would serve as a next-generation AMR network. This network aims to train researchers for multi-team, multidisciplinary partnerships on a global scale. The envisioned NTN collaboration would involve members from both lower- and middle-income nations (LMICs) and high-income countries (HICs), ensuring representation from diverse economies, locations, climates, cultures, and resources across multiple continents [72]. An example of an organization that aligns with this vision is the Global Alliance for Rapid Diagnostics (GARD), established in 2016. GARD operates as a peer-to-peer partnership representing scientists and practitioners from various disciplines interested in AMR (https://www.egr.msu.edu/alocilja/GARD-location/global-alliance-rapid-diagnostics-gard). GARD has facilitated the formation of six regional networks, covering North America, Latin America, Southeast Asia, South Asia, East Asia, and Africa. The diagram in Fig. 6 illustrates how the proposed multidimensional, next-generation AMR network would leverage regional and disciplinary knowledge within nodes while establishing new connections between regional networks. This collaborative approach aims to enhance the capacity for research, innovation, and implementation of solutions to combat AMR on a global scale.

Fig. 6

Aspects of next generation AMR networking

The integration of field data, algorithms, big data analytics, connected devices, and human input presents new opportunities for the management of Advanced Medical Devices (AMR). Leveraging digital technology and data strategically can contribute to the digital transformation of various industries, potentially mitigating the consequences of AMR [76]. The increasing availability of medical data and the application of artificial intelligence (AI) can enable rapid diagnosis of AMR, foster scientific breakthroughs, and support the development of new products and services for AMR control. These benefits can be realized at local and regional levels by compiling a comprehensive list of existing data sources and their characteristics [24]. To address the global challenge of AMR, the proposed next-generation AMR network aims to bring together diverse organizations. The network emphasizes professional development through training, research exchanges, and knowledge-sharing events. The goal is to equip the next generation with skills in communication, collaboration, and leadership, preparing them for multidisciplinary, collaborative research efforts. The Cyber Ambassadors program, funded by the National Science Foundation, offers modular and customizable training, including a "train-the-trainers" component that enables local facilitators to provide ongoing training, facilitating rapid scaling and deployment of professional development on a global scale [17]. In addition to training initiatives, researchers are exploring the creation of antibacterial substitutes as another strategy to combat AMR. This multifaceted approach underscores the importance of technological innovation, education, and global collaboration in addressing the complex issue of antimicrobial resistance.

Table1 shows some of the alternatives to antibiotics.

Table 1 Alternative to antibioticsSignificance of SDGs: importance and implications

The Millennium Development Goals (MDGs) represent a comprehensive set of development objectives adopted by numerous countries to address their unique needs and challenges (Fig. 7) [13]. These goals provide a framework for global collaboration with the shared aim of halving world poverty, saving millions of lives, and enhancing the well-being of billions of people in a sustainable manner [83].

Fig. 7

Millennium development goals

Efforts to achieve the MDGs have been varied globally, with a significant focus on addressing infectious diseases and improving maternal and child health. However, attention to establishing international partnerships and promoting sustainable environmental development has been comparatively limited. Despite considerable international and national efforts, progress has been uneven across different regions of the world. The rapid development of several Asian nations, including China, India, Indonesia, and Vietnam, has played a crucial role in the reduction of global poverty [54]. However, challenges persist, with 15.5% of the world's population still living in hunger, and many African countries facing difficulties in achieving the targeted two-thirds reduction in child mortality by 2015. Maternal mortality rates, particularly in Southern Asia and sub-Saharan Africa, remain high, reflecting the slow progress in these regions where 80% of the world's poorest people reside [33]. The MDGs have provided a valuable framework for international collaboration and goal-setting, laying the groundwork for subsequent initiatives such as the SDGs, which build on the achievements and lessons learned from the MDG era.

The United Nations General Assembly introduced the SDGs for the period 2016–2030 as a more comprehensive successor to the Millennium Development Goals (MDGs). Unlike the MDGs, the SDGs convey a clear message to all United Nations member countries: successful goal attainment requires collective action from every nation. The SDGs consist of 17 objectives and 169 targets, surpassing the MDGs in scope by addressing the root causes of poverty and emphasizing universal development for the benefit of all of humanity [63]. While the MDGs faced challenges, particularly in terms of funding limitations that hindered progress in poorer countries, the SDGs took a more inclusive approach. They emphasize equal human rights and development for both developing and developed nations [51]. The SDGs actively involve both the public and private sectors to facilitate global sustainability. They also highlight individual behavior changes as a crucial tool for achieving environmental sustainability. Aligned with Agenda 2030, the global goals stress the importance of "mobilizing global partnerships" to foster cross-border collaboration, allowing individuals and nations to collectively address the needs of less developed countries [52]. The SDGs, with their holistic and collaborative approach, represent a more ambitious and interconnected framework for addressing global challenges compared to the earlier MDGs.

The SDGs, with their numerous objectives, targets, and supporting activities, pose a challenge for governments and international agencies due to the complexity of whole systems thinking [63]. While early mapping exercises have illustrated the interconnections between various objectives, it is evident from past performance that there may be a lack of expertise in handling trade-offs and unexpected outcomes [66]. It is crucial to set priorities among objectives and assess how they might impact other goals. The challenge lies in developing innovative solutions for contemporary issues related to energy, agricultural productivity,