INTRODUCTION:
Antibiotic resistance is a natural phenomenon that has been significantly intensified by the inappropriate and excessive use of antimicrobial agents. Currently recognized as one of the greatest global public health threats, bacterial resistance compromises treatment effectiveness, prolongs infections, increases mortality rates, and raises healthcare costs. This review aims to discuss the main mechanisms of bacterial resistance, its clinical and public health impacts, and current strategies for prevention and control.

METHODS:
A narrative literature review was conducted based on scientific articles, reports, and guidelines published by international health organizations and peer-reviewed journals. Databases and official publications were consulted to address microbiological, clinical, epidemiological, and environmental aspects of bacterial resistance.

RESULTS:
The review identified key resistance mechanisms, including enzymatic inactivation of antibiotics, modification of drug targets, reduced membrane permeability, and activation of efflux pumps. The spread of multidrug-resistant bacteria has been particularly evident in hospital environments, significantly affecting patient outcomes and limiting therapeutic options. Additionally, environmental dissemination and the use of antibiotics in agriculture contribute to the global circulation of resistance genes. Current strategies emphasize rational antibiotic use, infection control measures, epidemiological surveillance, and the development of new antimicrobial therapies.

CONCLUSIONS:
Bacterial resistance represents a complex and multifactorial challenge that extends beyond clinical settings, requiring coordinated global action. Effective control depends on integrated strategies involving antimicrobial stewardship, public health policies, scientific innovation, and a One Health approach. Strengthening these measures is essential to preserve the effectiveness of existing antibiotics and ensure the sustainability of healthcare systems worldwide.