Not a week goes by without us witnessing a conference or workshop on bacterial resistance to antibiotics. Slides are presented, recommendations are mentioned, and WHO guidelines are quoted. However, the real criterion is not the number of conferences, but rather the performance indicators on the ground. After forty years of clinical practice, the digital divide between discourse and implementation appears wider than we imagine.

Here are 12 KPIs that reflect reality as it is, not as it is intended to be:
1. Over-prescription of antibiotics for upper respiratory infections
The rate of prescribing antibiotics in these cases reaches 50-70 percent, while evidence indicates that more than 70 percent of these cases are viral and do not require antibiotics. This means that at least a third of the prescriptions are not scientifically justified.
2. Start treatment before taking a culture
In more than 60 percent of hospitalizations, the first dose is given before a sample is collected for culture, which impairs diagnostic accuracy and distorts local resistance patterns.
3. The absence of an institutional antibiotic
Less than a third of health institutions publish an updated annual bacterial susceptibility report, although this report is the basis for rational empirical treatment selection.
4. Weak transition from broad spectrum to narrow spectrum
After the transplant results are issued, the treatment spectrum is reduced only in about 40 percent of cases, while the percentage is supposed to exceed 70 percent according to modern stewardship standards.
5. High consumption of antibiotics
In some settings, consumption exceeds 30 standard daily doses per 1,000 population, compared to 15–18 in more disciplined health systems. The difference is nearly double.
6. Resistance of Escherichia coli to third-generation cephalosporins
Resistance rates range between 40 and 60 percent in some regional reports, effectively limiting first-line options.
7. The rise of Klebsiella resistance to carbapenems
It exceeded 20 percent in some centers, a number approaching the threshold of becoming a hospital-acquired infection crisis.
8. Weakness of Antimicrobial Stewardship Programs
Less than 25 percent of hospitals have an integrated team with clear executive authority that includes a physician, clinical pharmacist, microbiologist, and infection control nurse.
9. Marginalization of the clinical pharmacist
Involving the clinical pharmacist in the treatment decision reduces unnecessary consumption by up to 20 percent, yet his role is reduced to administrative dispensing in most institutions.
10. Limited rapid tests
Availability of Rapid Antigen or molecular diagnostic tests is only 35 percent in some facilities, although they can reduce unwarranted antibiotic prescribing by up to 30 percent.
11. Dispensing antibiotics without a prescription
In some communities, the percentage ranges between 20 and 50 percent, undermining any national rationalization policy.
12. Global burden of mortality
Antibiotic resistance causes approximately 1.27 million direct deaths annually globally, with expectations of reaching 10 million deaths annually by 2050 if practice patterns do not change radically.

The deeper point is not a single number, but an entire behavioral structure:
A doctor fears complaints more than he fears bacterial resistance.
Restricted nursing is not involved in the decision.
Marginalized clinical pharmacist.
Lack of accurate local data.
An administration that is content with recommendations without digital accountability.

Conclusion
Antibiotic resistance is not a crisis of knowledge, but rather a crisis of application.
It’s not a lack of conferences, it’s a lack of digital accountability.
The true benchmark for any health system is not what is said on the platform, but the proportion of cultivation before the first dose, the number of annual reports published, the proportion of conversion to a narrower spectrum, and the decline in resistance rates year after year.

When indicators become mandatory rather than optional, and when performance is measured by numbers rather than slogans, only then can we say that we have begun a real confrontation with bacterial resistance — not just talk about it.

* Consultant in Clinical Immunology and Rheumatology