Reviewed by Erica Stohs, MD, MPH, University of Nebraska
In this systematic analysis, investigators estimate that 4.95 million deaths were associated with bacterial antimicrobial resistance (AMR) in 2019, including 1.27 million deaths directly attributable to such resistance.
A team of 140 investigators worldwide, termed the Antimicrobial Resistance Collaborators, gathered data from published literature, hospital systems, surveillance systems and other sources from 471 million individual vs isolate records to develop statistical models to estimate the global burden of bacterial AMR in 2019. They estimate deaths and disability-adjusted life-years (DALYs) attributed to and associated with bacterial AMR for 23 pathogens and 88 drug-bug combinations. Models were applied to a 2019 age- and sex-specific estimates of disease burden for more than 350 diseases/injuries in over 200 countries (Global Burden of Diseases, Injuries, and Risk Factors Study 2019).
The estimate of associated deaths (4.95 million) was based on the counterfactual scenario in which all drug-resistant infections were replaced by no infection. The estimate of directly attributable deaths (1.27 million) was based on the counterfactual scenario in which all drug-resistant infections were replaced by drug-susceptible infections.
Three infectious syndromes accounted for nearly 80% of AMR burden: lower respiratory infections, bloodstream infections, and intra-abdominal infections in that order. Burden of AMR is not distributed equally: Sub-Saharan Africa and south Asia suffers greatest with AMR-associated death rates over 75 per 100,000; Australia had the lowest burden (28 per 100,000).
The six leading pathogens, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa, accounted for 930,000 attributable AMR deaths. Among pathogen-drug combinations, MRSA led with over 100,000 attributable deaths. The next six pathogen-drug combinations causing between 50-100 thousand deaths each were MDR/XDR tuberculosis, 3rd gen cephalosporin-resistant E. coli and K. pneumoniae, carbapenem-resistant A. baumannii, quinolone-resistant E. coli, and carbapenem-resistant K. pneumoniae.
While antimicrobial stewardship efforts aimed to reduce antibiotic consumption are important, the lack of laboratory and basic microbiological testing in low-resource settings suffering high burdens of AMR-driven infectious syndromes also warrants urgent attention.
Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet 2022;399(10325):P629-655. DOI: https://doi.org/10.1016/S0140-6736(21)02724-0.