In Malaysia, a quiet but formidable threat is growing within hospitals and communities: bacteria that are increasingly resistant to antibiotics. According to the Health Ministry, two types of bacteria, Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), have shown a troubling rise in resistance rates over recent years, climbing from around 25% in 2019 to 30% in 2023 for E. coli, and from 11.6% to 19.9% for K. pneumoniae over the same period. While the ministry describes the increase as occurring at “a slow rate,” the broader implications of antimicrobial resistance (AMR) paint a far graver picture for public health, both in Malaysia and globally.
A Growing Threat in Hospitals and Beyond
The rise in antibiotic resistance among bacteria like E. coli, which commonly causes urinary tract and wound infections, and K. pneumoniae, linked to severe respiratory infections, signals a future where common infections could become harder to treat. The National Antibiotic Resistance Surveillance Report (NASR) 2023, released by the Health Ministry, highlights that some bacteria in Malaysia exhibit resistance rates as high as 92% against certain antibiotics, though specifics on these strains remain less detailed in public disclosures. More alarmingly, a study conducted at a hospital in Terengganu by local and international researchers revealed that resistant bacteria can transfer their immunity to other species through plasmids—small DNA structures that act as toolkits for spreading resistance. 
“Some plasmids could be transferred to other species of bacteria, and this complicates our fight against AMR” said Prof Dr Yeo Chew Chieng of Universiti Sultan Zainal Abidin, who led the research. His team’s findings, based on a decade of data, showed that 97% of Acinetobacter baumannii samples—a notorious multidrug-resistant bacterium often found in healthcare settings—carried these plasmids. This ability to share resistance mechanisms could potentially create new superbugs, a concern Prof Yeo notes is not unique to Malaysia but is a pressing global issue, underscored by the World Health Organization (WHO) listing AMR as a top public health threat.
Pandemic Fallout and Persistent Challenges
The rise in resistance rates for certain bacteria, such as Acinetobacter baumannii and Pseudomonas aeruginosa, which can cause pneumonia and other severe infections, saw a notable spike during the COVID-19 pandemic. The Health Ministry attributes this to the complexity of managing COVID-19 cases, where patients often required multiple antibiotic therapies, inadvertently fostering resistance. “Some case management required multiple antibiotic therapy, leading to AMR development during the pandemic” the ministry explained. While resistance rates for these bacteria have since stabilized, the upward trend for E. coli and K. pneumoniae persists, with resistance to the antibiotic Ciprofloxacin—a common treatment—showing significant increases.
Experts point to multiple factors driving AMR, including the overprescription of antibiotics in healthcare settings and their overuse in agriculture, particularly in poultry, livestock, and aquaculture industries. Prof Yeo warns that livestock, often given antibiotics to prevent disease and promote growth, could serve as reservoirs for resistant bacteria and genes. “This is indeed a very dangerous practice as many studies have shown that bacteria from livestock and animals could be reservoirs for not only potential bacterial pathogens but also AMR genes” he said. Without stringent controls, these practices risk amplifying the spread of resistance beyond clinical environments into everyday life.
Personal Stories Highlight the Human Cost
The impact of AMR is not just a statistic—it is deeply personal for many. Dr. Jasmine E. Khairat, assistant coordinator at Universiti Malaya’s Centre for Natural Product and Drug Discovery, shared a harrowing experience involving her father. After weeks of coughing, he suffered a seizure and was admitted to the Intensive Care Unit, where K. pneumoniae was identified as the culprit. “He ended up spending two weeks in the hospital” she recalled, emphasizing the varying levels of resistance among superbugs across different regions and healthcare facilities in Malaysia. Such stories underline the urgent need for continuous surveillance to track resistance trends and inform treatment strategies.
Similarly, Dr. Muhamad Afiq Aziz, a senior lecturer at Universiti Malaya’s Institute of Biological Sciences, highlighted the challenges posed by multidrug-resistant Pseudomonas aeruginosa, often found in hospital settings. “Its resistance to multiple classes of antibiotics makes treatment particularly challenging” he noted. His ongoing research, supported by the Higher Education Ministry, explores alternatives like antivirulence agents, which disarm bacteria by targeting their harmful mechanisms rather than killing them outright, potentially reducing the selective pressure that drives resistance.
Malaysia’s Response: A One Health Approach
Amid these challenges, Malaysia is taking proactive steps to curb AMR. The Health Ministry, through its National Antimicrobial Resistance Committee, is enhancing surveillance systems and promoting the responsible use of antibiotics across human, animal, and environmental sectors. “The ministry is dedicated to combating this growing threat through a comprehensive One Health approach” it stated, emphasizing the interconnected nature of AMR across health domains. This collaborative strategy involves careful application of antibiotics in hospitals, clinics, and agricultural settings to minimize unnecessary exposure.
Yet, experts argue that more needs to be done. Dr. Jasmine calls for expanded surveillance systems to track AMR trends and antibiotic usage comprehensively, while Prof Yeo stresses the need for better genomic surveillance to identify specific bacterial strains and lineages. “If we don’t know the type of bacteria that are causing infections, it will be very difficult to counter this threat” he warned. Such data is crucial for crafting targeted policies on antibiotic prescriptions and avoiding a scenario where resistance outpaces the development of new drugs—an outcome he describes as a potential “antibiotic apocalypse.”
Global Context and Local Action
Malaysia’s struggle with AMR is part of a broader global crisis. The WHO estimates that, without intervention, AMR could claim millions of lives worldwide by mid-century, with Malaysia alone projected to lose around 87,000 lives between 2020 and 2030 if current trends continue. The slow pace of new antibiotic development exacerbates the problem, as resistant bacteria evolve faster than pharmaceutical innovation can keep up. In response, researchers like Dr. Muhamad Afiq advocate for government investment in alternatives such as bacteriophages—viruses that target bacteria—and other novel therapies to complement traditional antibiotics.
At the individual level, every Malaysian has a role to play. Simple actions, such as adhering to prescribed antibiotic courses, avoiding self-medication, and supporting policies that limit antibiotic use in agriculture, can help reduce the selective pressure that fuels resistance. “By using fewer antibiotics in general, we reduce this pressure, giving fewer bacteria the chance to develop and pass on resistance” Dr. Muhamad Afiq explained. Public awareness and behavioral change, paired with robust policy interventions, are critical to preventing AMR from spiraling out of control.
Looking Ahead: A Race Against Time
As Malaysia grapples with rising antibiotic resistance, the stakes could not be higher. The incremental increases in resistance among common bacteria like E. coli and K. pneumoniae, coupled with the potential for resistance to spread across species, pose a formidable challenge to healthcare systems already strained by past pandemics and ongoing resource constraints. While the Health Ministry’s commitment to a One Health approach offers hope, the warnings from experts about data gaps and the need for innovative solutions underscore the urgency of the situation.
The fight against AMR is a race against time, one that requires coordinated action across sectors and borders. For now, Malaysia stands at a critical juncture, balancing immediate responses with the long-term vision needed to safeguard public health. As Prof Yeo poignantly noted, the alternative—a world where bacterial infections become untreatable—is a future no one can afford to ignore.
