The Lancet: The death toll exceeds AIDS! Infections with drug-resistant bacteria are a major global health problem

▎ WuXi AppTec content team editor

With the gradual evolution of microbial pathogens, coupled with the overuse and misuse of some drugs, antimicrobial resistance (AMR) has become one of the major public health threats in the 21st century. The Antibiotic Resistance Study, commissioned by the UK government, shows that by 2050, the number of deaths due to antibiotic resistance is expected to be 10 million per year.

A major challenge in addressing AMR is understanding the true burden of drug resistance, especially in areas with minimal surveillance and sparse data. To date, however, no comprehensive evaluation studies covering all regions and a wide range of pathogens and drug combinations have been published.

Recently, The Lancet published a study in which it said it was "the most comprehensive analysis to date of the global impact on antibiotic resistance." The analysis shows that more than 1.2 million people died from antibiotic-resistant infections in 2019, higher than deaths from HIV/AIDS or malaria.

Screenshot source: The Lancet

The study assessed the death and disability-adjusted life years (DALYs) of bacterial AMRs (i.e., antibiotic-resistant infections) associated with 23 pathogens and 88 pathogen-drug combinations in 2019 in 204 countries and territories. This systematic analysis assesses the burden of disease in two ways: deaths directly due to AMR, and deaths indirectly due to AMR (i.e., antibiotic-resistant infections are associated with death, but are not necessarily direct causes).

The analysis first showed that the burden of death from antibiotic-resistant infections was extremely high:

In 2019, antibiotic-resistant infections directly caused about 1.27 million deaths worldwide and indirectly caused about 4.95 million deaths. HIV/AIDS and malaria caused 860,000 and 640,000 deaths in 2019, respectively.

Resistance to lower respiratory tract infections, such as pneumonia, has the greatest impact on the AMR disease burden, resulting in more than 400 000 direct deaths and more than 1.5 million indirect deaths. Drug resistance to bloodstream infections can lead to life-threatening sepsis, resulting in about 370 000 direct deaths and 1.5 million indirect deaths. Intra-abdominal infection resistance is usually caused by appendicitis, resulting in about 210 000 direct deaths and 800 000 indirect deaths.

While AMR poses a threat to people of all ages, studies have found that young children are at very high risk, with about 1 in 5 AMR deaths occurring in children under the age of five.

Greater impact on low- and middle-income countries and regions:

Antibiotic resistance is already a global health threat, and although high-income countries also face alarmingly high levels of antibiotic resistance, it has the most severe impact on low- and middle-income countries. Deaths directly attributable to AMR are highest in sub-Saharan Africa and South Asia, at 24/100,000 and 22/100,000, respectively. In sub-Saharan Africa, AMR indirectly caused 99 deaths per 100,000 deaths; in South Asia, AMR indirectly caused 77 deaths per 100,000 deaths. In high-income countries, AMRs directly resulted in 13 deaths per 100,000 people and indirect deaths of 56 people per 100,000 people.

The effects of pathogens vary from place to place, with amR deaths most commonly caused by Acinetobacter baumannii (16%) or pneumococcal bacteria (20%), while about half of amR deaths in high-income countries are caused by Staphylococcus aureus (26%) or E. coli (23%).

Among the problems of drug resistance, 6 major pathogens and two major classes of antibiotics are of particular concern:

Of the 23 pathogens studied, only 6 of the main resistant pathogens (E. coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa) directly caused 929 000 deaths and 3.57 million indirectly. Methicillin-resistant Staphylococcus aureus (MRSA), a pathogen-drug combination, directly caused more than 100,000 deaths in 2019, while the other six contributed to 50,000 to 100,000 deaths each.

Among all pathogens, fluoroquinolone antibiotics and β-lactam antibiotics are often considered the first line of defense against serious infections, and these two types of antibiotic resistance are estimated to account for more than 70% of deaths caused by AMR.

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The study also notes that a number of measures can help countries protect their health systems from AMR, such as rapid investment in new therapies, improved infection control measures, and optimized antibiotic use.

Professor Christiane Dolecek, co-author of the study and research leader of the AMR Global Research Programme at the University of Oxford, said, "Due to the wide disparities in antibiotic resistance between different countries and regions, improving data collection on a global scale is critical to help us better track resistance levels and provide clinicians and policymakers with the information they need to address the pressing challenges posed by AMR. ”