Infections caused by drug-resistant bacteria are among the leading causes of death for people of all ages, finds the most comprehensive global study of antimicrobial resistance (AMR) yet.

The analysis1, published in The Lancet on 19 January, estimates that in 2019, 4.95 million people died from illnesses in which bacterial AMR played a part. Of those, 1.27 million deaths were the direct result of AMR — meaning that drug-resistant infections killed more people than HIV/AIDS (864,000 deaths) or malaria (643,000 deaths).

“AMR is truly a global problem that requires urgent action from policymakers and the health community to avoid preventable deaths,” says Mohsen Naghavi, a health-metrics scientist at the University of Washington in Seattle who was part of the research team.

The proportion of bacteria that are resistant to antibiotics is on the rise. “In a world where antibiotic use has become so commonplace, resistant bacteria out-compete those that are killed off by pharmaceuticals,” says Naghavi. A 2016 review on antimicrobial resistance estimates that by 2050, as many as ten million people could die each year as a result of AMR. If the situation is left unchecked, “infections that were previously curable with a few days of antibiotics could become incurable”, Naghavi warns.

Although there are many studies on the effects of AMR, few have tried to estimate its global impact. Naghavi and his colleagues used data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD) — a survey2 of 369 diseases and injuries among people of all ages in 204 countries and territories — to estimate the number of people who died from infections globally, along with the pathogens responsible and other factors. The team then used all available data on AMR to calculate the prevalence of bacterial AMR in various locations, and the impact that resistance had on mortality.

The team found that in 2019, 1.27 million deaths were directly caused by bacterial AMR, and more than twice that number were associated with it. The three most common sites for bacterial AMR infections were the chest, bloodstream and abdomen — infections in these parts of the body accounted for 78.8% of directly attributable AMR deaths. The six deadliest bacterial pathogens were responsible for nearly three-quarters of all deaths attributed to resistance (see ‘Deadly infections’). Antibiotic-resistant Escherichia coli alone killed around 200,000 people in 2019.

Tailor-made approach

The figures show that lower-income countries experience the highest rates of AMR-related death. Among the 21 GBD geographical regions, Western sub-Saharan Africa had the highest rate of deaths directly attributable to AMR, with 27.3 per 100,000 people. Australasia had the lowest, with 6.5 deaths per 100,000 people. Both the prevalence of resistance and the number of infections with resistant bacteria are higher in low-income regions than in wealthier countries. Reasons for this include poor sanitation and hygiene, insufficient facilities for testing to inform treatment, and a lack of access to the newest antibiotics and vaccines. “Regional estimates are useful for policy planning specific to the challenges faced by each region,” says Naghavi. “One-size-fits-all approaches are unlikely to be appropriate.”

David Weiss, who studies antibiotic resistance at Emory University in Atlanta, Georgia, says that this study is a “wake-up call”, but points out that data on AMR in many low- and middle-income countries are scarce. “This highlights the need to greatly expand laboratory capacity in these regions so we can more accurately understand the size and nature of this monster we’re fighting,” Weiss says. “Immediate and transformational increases in attention and investment are needed. We cannot wait a minute longer.”

Source: nature

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