From surveillance to stewardship: addressing antimicrobial resistance in Central Asia’s healthcare

SUMMARY Antimicrobial resistance (AMR) is a public health threat that requires a coordinated and multi-sectoral approach. AMR is largely underexplored in Central Asia, a region shaped by the Soviet legacy. This narrative review aimed to synthesize evidence on the AMR landscape from articles published in five countries: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. A structured search of peer-reviewed and gray literature was conducted, covering AMR prevalence, consumption patterns, knowledge, awareness, practices, stewardship interventions, and AMR governance. Key findings revealed that all five countries in the region have retained the rigidly centralized public health system, which was formerly known as the Sanitary Epidemiological Service during the Soviet era. This has led to fragmented surveillance and poor AMR monitoring. Up to 70% of Enterobacterales spp. were resistant to third-generation cephalosporins, and up to 58% of Staphylococcus species exhibited macrolide resistance. Consumption of Watch group antibiotics ranged from 53% to 68%, with a broad preference for injectables. Self-medication was found to be common, with rates ranging between 26% and 40% among the general public. High levels of patient demand coincided with medical errors, affecting up to 80% of antibiotic prescriptions. Only a limited number of antimicrobial stewardship studies were found, highlighting the insufficient integration of stewardship practices into routine healthcare delivery. Central Asian countries continue to face significant challenges because of the persistence of poor surveillance, high antibiotic consumption, and inadequate implementation of AMS because of long-standing legacies and systemic weaknesses. Addressing these gaps demands structural reforms, integrated surveillance systems, targeted education, and robust stewardship programs as urgent priorities.