Story so far: Antimicrobial resistance (AMR), or antibiotics becoming ineffective because pathogens such as viruses, fungi and bacteria become resistant to them, has long been recognised as a major threat to public health. However, there are few estimates on the scale of the problem and regional variations. Based on estimates from 204 countries and territories, the Global Research on Antimicrobial Resistance (GRAM) report published in the Lancet on Thursday provides the most comprehensive estimate of the global impact of AMR so far.
What did the GRAM report find?
Its headline finding is that as many as 4.95 million deaths may be associated with bacterial AMR in 2019. Estimates included in the paper show that AMR is a leading cause of death globally, higher than HIV/AIDS or malaria. In South Asia, over 389,000 people died as a direct result of AMR in 2019. The death rate was the highest in Western sub-Saharan Africa, at 27.3 deaths per 100,000 and lowest in Australasia, at 6.5 deaths per 100,000. Lower respiratory-tract infections accounted for more than 1.5 million deaths associated with resistance in 2019, making it the most common infectious syndrome. The six leading pathogens for deaths associated with resistance were Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. They were responsible for 3.57 million deaths associated with AMR in 2019. One pathogen–drug combination, meticillin-resistant S aureus, caused more than 100,000 deaths attributable to AMR in 2019, while six more each caused 50 000 – 100,000 deaths.
How was this study done?
GRAM is led out of the University of Oxford Big Data Institute – IHME Strategic Partnership.IHME is the Institute for Health Metrics. The research paper lists a large number of contributors from across the world who provide data from multiple sources, including microbiology data, inpatient data, data on multiple causes of death, and pharmaceutical sales data. The data was then broken down, by region, into deaths in which infection played a role by infectious syndrome; pathogen distribution for deaths and incident cases; incidence of infectious syndromes disaggregated by age, sex, and location; prevalence of resistance by pathogen; relative risk of death for drug-resistant infection compared with drug-sensitive infections and finally, computing the burden attributable to drug resistance and burden associated with drug-resistant infections.
What are the implications of this study?
Common infections such as lower respiratory tract infections, bloodstream infections, and intra-abdominal infections are now killing hundreds of thousands of people every year because bacteria have become resistant to treatment. This includes historically treatable illnesses, such as pneumonia, hospital-acquired infections, and foodborne ailments. Everyone is at risk from AMR, but the data shows that young children are particularly affected. In 2019, one in five global deaths attributable to AMR occurred in children under the age of five – often from previously treatable infections. AMR is threatening the ability of hospitals to keep patients safe from infections and undermining the ability of doctors to carry out essential medical practice safely, including surgery, childbirth and cancer treatment since infection is a risk following these procedures.Between 1980 and 2000, 63 new antibiotics were approved for clinical use. Between 2000 and 2018, just 15 additional antibiotics were approved. Out of the seven deadliest drug-resistant bacteria, vaccines are only available for two (Streptococcus pneumoniae and Mycobacterium tuberculosis). Whilst all seven of the leading bacteria have been identified as ‘priority pathogens’ by the World Health Organization (WHO) only two have been a focus of major global health intervention programmes – S. pneumoniae (primarily through pneumococcal vaccination) and M. tuberculosis.
What do the authors suggest as the way forward?
They recommend greater action to monitor and control infections, globally, nationally and within individual hospitals. Access to vaccines, clean water and sanitation ought to be expanded. The use of antibiotics unrelated to treating human disease, such as in food and animal production must be “optimised” and finally they recommend being “more thoughtful” about our use of antimicrobial treatments – expanding access to lifesaving antibiotics where needed, minimising use where they are not necessary to improve human health and acting according to World Health Organisations recommendations on the same. They also recommend increasing funding for developing new antimicrobials and targeting priority pathogens such as K. pneumoniae and E. coli and ensuring that they are affordable to accessible to most of the world.