Reckoning with the global toll of antimicrobial resistance
May / June 2022 | Volume 21 Number 3
Photo courtesy of CDC Antibiotic Resistance Coordination and Strategy Unit
Acinetobacter bacteria causes pneumonia and wound, bloodstream, and urinary tract infections. Nearly all infections happen in patients who recently received care in a healthcare facility.
Following his 1928 discovery of penicillin, biologist Alexander Fleming warned that overuse of the drug could lead to resistant bacteria. Nearly 100 years later, the world is grappling with this reality. Resistance develops when bacteria acquire, through genetic mutation or genetic transfer, new characteristics rendering them impervious to the drugs meant to kill them. Ranked by the WHO as one of the top 10 global health threats, antimicrobial resistance (AMR)—when not only antibiotics but also antivirals, antifungals and antiparasitics lose power—makes infections difficult or impossible to treat and raises the risk of disease severity and spread.
Resistant pathogens end more lives than HIV/AIDS or malaria: 1.27 million people died in 2019 as a direct result of AMR, as estimated by an international team of scientists in a
report published earlier this year by
The Lancet. The team calculated an additional 4.95 million AMR-associated deaths.
“One of the most sobering findings in our study was that AMR disproportionately affects young children,” the study’s lead author, Dr. Chris Murray of the Institute for Health Metrics and Evaluation, University of Washington, told Fogarty in an email. Children under 5 represent roughly one in every five AMR-linked deaths.
LMIC burden
The researchers estimated disease burden for 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019. No nation is immune to AMR yet it is low- and middle-income countries (LMICs), home to nearly 85% of the world’s population, that shoulder the highest burden. The magnitude of the problem is difficult to assess given the lack of rigorous surveillance and data in LMICs.
“We based our approach on 471 million individual records or isolates (not projections) from 7,585 study-location-years, making it the most comprehensive study of AMR to date,” explained Murray. Location-years of data refer to unique Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) locations and years for which the team has records or laboratory cultures. GBD, a complete assessment of data on diseases and injuries, was initiated in 1992 under principal investigator Murray as a collaborative effort of hundreds of experts worldwide.
Western sub-Saharan Africa (SSA) had the highest estimated death rates: 27.3 deaths per 100,000 people attributable to AMR and 114.8 per 100,000 associated with AMR. Five regions—south Asia and all four SSA regions—had AMR associated death rates higher than 75 per 100,000. By comparison, high-income regions had a direct AMR death rate of 13 per 100,000 and an associated death rate of 55.7 per 100,000.
Higher death rates in lower resource regions are due to greater prevalence of resistant pathogens, the use of counterfeit or substandard antibiotics, limited laboratory capacity, higher frequency of critical infections, inadequate access to second- and third-line antibiotics, and poor sanitation and hygiene, according to the authors.
Photo courtesy of CDC Antibiotic Resistance Coordination and Strategy Unit Staphylococcus aureus are common bacteria that spread in healthcare facilities and the community. MRSA can cause difficult-to-treat staph infections because of resistance to some antibiotics.
Three types of infections accounted for 78.8% AMR deaths in 2019, the report found: lower respiratory and thorax, bloodstream, and intra-abdominal. Of the deaths directly attributable to AMR, an estimated 73% (929,000) were caused by six pathogens:
Escherichia coli,
Staphylococcus aureus,
Klebsiella pneumoniae,
Streptococcus pneumoniae,
Acinetobacter baumannii, and
Pseudomonas aeruginosa. These six pathogens also accounted for nearly three-quarters of the total AMR-associated deaths.
“What is important to emphasize is that out of the seven deadliest bacteria resistant to antibiotics, vaccines are currently only available for two (Streptococcus pneumoniae and
Mycobacterium tuberculosis),” stated Murray. “One of the aims of such breadth and novelty in our approach was to help clinicians make faster, life-saving choices and reduce the use of antimicrobial agents where expectations of effectiveness are low.”
Murray concluded, “Future work should combine the data from humans, animals and environment within the framework of ‘One Health’ to accurately reflect the intertwined nature of AMR. This means multisectoral partnership between the research community and other experts (such as physicians, pharmacists, public health and veterinary specialists) is needed.”
Within Fogarty’s One Health portfolio is a
Redeemer’s University project supported by the National Institute of Allergy and Infectious Diseases and the NIH Office of the Director. Helmed by Dr. Christian Happi, the research will examine AMR trends and dynamics of transmission in Eastern and Western Africa; create a portable screening tool for clinical care; and explore potential benefits of enhancing antibiotic efficacy against multidrug-resistant bacteria.
More Information
Updated June 15, 2022
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