The first comprehensive analysis of the global impact of antimicrobial resistance (AMR) estimates that resistance itself caused 1.27 million deaths in 2019, and that antimicrobial-resistant infections played a role in 4.95 million deaths.
- Estimates for 204 countries and territories confirm that AMR is a global health threat, with worst impacts in low- and middle-income countries (LMICs), although higher-income countries also face alarmingly high levels of AMR.
- Rapid investment in new treatments, improved infection control measures and optimized use of antibiotics are some of the measures that can help countries protect their health systems against the threat of AMR.
- More than 1.2 million people, and potentially millions more, died in 2019 as a direct result of antibiotic-resistant bacterial infections, according to the most comprehensive estimate to date of the global impact of antimicrobial resistance (AMR).
The analysis of 204 countries and territories, published in The Lancet , reveals that AMR is now one of the leading causes of death worldwide, above HIV/AIDS or malaria.
It shows that many hundreds of thousands of deaths now occur due to common infections that were previously treatable, such as lower respiratory tract and bloodstream infections, because the bacteria that cause them have become resistant to treatment.
The report highlights the urgent need for increased action to combat AMR and outlines immediate actions for policymakers that will help save lives and protect health systems. These include optimizing the use of existing antibiotics, taking more measures to monitor and control infections, and providing more funding to develop new antibiotics and treatments.
Study co-author Professor Chris Murray, from the Institute for Health Metrics and Evaluation, University of Washington, US, said: "These new data reveal the true scale of antimicrobial resistance around the world. and they are a clear sign that we must act now to combat the threat. Previous estimates had predicted 10 million deaths annually from antimicrobial resistance by 2050, but we now know for sure that we are already much closer to that number than we previously thought. "We need to harness this data to course-correct and drive innovation if we want to stay ahead in the race against antimicrobial resistance."
Estimates of the health effects of AMR have been published for several countries and regions, and for a small number of pathogen-drug combinations in a broader range of settings. However, no estimate so far has covered all locations and a wide range of pathogens and drug combinations.
The new Global Research on Antimicrobial Resistance (GRAM) report estimates deaths related to 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019. Statistical models were used to produce estimates of the impact of AMR on all sites, including those with no data: using 471 million individual records obtained from systematic literature reviews, hospital systems, surveillance systems, and other data sources.
The burden of disease was estimated in two ways: deaths caused directly by AMR (i.e., deaths that would not have occurred if the infections had been susceptible to drugs and therefore more treatable) and deaths associated with AMR ( that is, when a drug-resistant infection was implicated in deaths, but the resistance itself may or may not have been the direct cause). Deaths caused by and associated with AMR were calculated for 204 countries and territories and reported for 21 global regions and seven superregions.
- The analysis shows that AMR was directly responsible for approximately 1.27 million deaths worldwide and was associated with approximately 4.95 million deaths in 2019.
- HIV/AIDS and malaria are estimated to have caused 860,000 and 640,000 deaths, respectively, in 2019.
Drug resistance in lower respiratory tract infections , such as pneumonia, had the greatest impact on the disease burden of AMR, causing more than 400,000 deaths and being associated with more than 1.5 million deaths.
Drug resistance in bloodstream infections , which can lead to the life-threatening condition sepsis, caused around 370,000 deaths and was associated with nearly 1.5 million deaths.
Drug resistance in intra-abdominal infections , commonly caused by appendicitis, directly led to around 210,000 deaths and was associated with around 800,000.
While AMR poses a threat to people of all ages, young children have been found to be at particularly high risk, with around one in five deaths attributable to AMR in children under five years of age.
Deaths directly caused by AMR were estimated to be highest in sub-Saharan Africa and South Asia, with 24 deaths per 100,000 population and 22 deaths per 100,000 population, respectively. AMR was associated with 99 deaths per 100,000 in sub-Saharan Africa and 77 deaths per 100,000 in South Asia. In high-income countries, AMR directly led to 13 deaths per 100,000 and was associated with 56 deaths per 100,000.
Of the 23 pathogens studied, drug resistance in only six (E. coli, S. aureus, K. pneumoniae, S. pneumoniae, A. baumannii, and P. aeruginosa) led directly to 929,000 deaths and was associated with 3 .57 million. One pathogen and drug combination, methicillin-resistant S. aureus or MRSA, directly caused more than 100,000 deaths in 2019, while six others each caused between 50,000 and 100,000 deaths.
Among all pathogens, resistance to two classes of antibiotics that are often considered the first-line defense against serious infections (fluoroquinolones and beta-lactam antibiotics) accounted for more than 70% of deaths caused by AMR.
The health impact of pathogens varied widely by location, with AMR-attributable deaths in sub-Saharan Africa most frequently caused by S. pneumoniae (16% of deaths) or K. pneumoniae (20%), while About half of the deaths attributable to AMR in high-income countries were caused by S. aureus (26%) or E. coli (23%).
“Given that resistance varies substantially by country and region, it is essential to improve data collection around the world to help us better track resistance levels and equip clinicians and policymakers with the information they need to address the challenges.” most pressing challenges posed by antimicrobial resistance. “We identified serious data gaps in many low-income countries, emphasizing the particular need to increase laboratory capacity and data collection in these locations,” said study co-author Professor Christiane Dolecek, GRAM Scientific Leader. based at the Center for Tropical and Global Medicine at the University of Oxford. Health and the Mahidol Oxford Tropical Medicine Research Unit (MORU). [1]
The authors acknowledge some limitations of their study. Limited data availability for some parts of the world, particularly many low- and middle-income countries, may limit the precision of the estimates in these locations, as this required strong methodological assumptions in the analysis. Combining and standardizing data from a wide variety of sources also led to some potential sources of bias, including misclassification of community- or hospital-acquired infections, and inconsistency in distinguishing between drug-susceptible and drug-resistant infections. . There is also the potential for selection bias in passive surveillance systems, and hospital microbial data from LMICs may be biased toward more urban populations or more severe disease.
Writing in a linked comment, Dr Ramanan Laxminarayan, Center for Disease Dynamics, Economics and Policy (US), who was not involved in the study, said: "If it is a hidden and unrecognized problem, a more clear of the burden of AMR finally emerging. Even the lower end of 911,000 deaths estimated by Murray and colleagues is higher than the number of deaths from HIV, which attracts about US$50 billion each year. However, the spending overall to address AMR is probably much lower than that needs to change. Spending should be directed at preventing infections in the first place, making sure existing antibiotics are used appropriately and judiciously, and bringing new antibiotics to market. "Political and health leaders at local, national and international levels must take serious action on the importance of addressing antimicrobial resistance and the challenge of poor access to effective and affordable antibiotics."
