Analysis of the Global Burden of Bacterial Antimicrobial Resistance in 2019

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Researchers conducted a systematic analysis to assess the global burden of antimicrobial resistance (AMR) and to estimate the number of deaths associated with or attributable to AMR in 2019.

Results of a study that assessed the global burden of antimicrobial resistance (AMR) found that AMR is a leading cause of death around the world, particularly in low-resource settings, and highlighted the need for location-specific policy decisions about infection prevention and control, according to results of a study published in The Lancet.

In this systematic analysis, researchers obtained data from literature reviews, hospital systems, and surveillance systems that included 471 million individual records and 7585 study-location-years. They sought to estimate deaths and disability-adjusted life-years (DALY) associated with and caused by bacterial AMR for 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019. A predictive statistical model was used to estimate the AMR burden for all locations, including those with no available data. To estimate the number of deaths attributable to or associated with AMR, the researchers assessed 5 broad components: number of deaths involving infection, proportion of infectious syndrome deaths attributable to a given pathogen, proportion of infectious deaths attributable to a given infectious syndrome, the percentage of a given pathogen with resistance to an antibiotic of interest, and the excess risk of death or duration of an infection associated with this resistance.

The researchers found that there were an estimated 4.95 (95% uncertainty level [UI], 3.62-6.57) million deaths associated with bacterial AMR, of which 1.27 million (95% UI, 0.911-1.71) were attributable to bacterial AMR.  Further analysis at the regional level showed that the estimated all-age death rate attributable to AMR was most increased in Western sub-Saharan Africa (27.3 deaths per 100,000), with the lowest rates found in Australasia (6.5 deaths per 100,000).  The researchers found that the most burdensome infectious syndrome was lower respiratory infection, representing more than 1.5 million deaths associated with AMR in 2019.

Among a total of 929,000 deaths (95% UI, 660,000-1,270,000) attributable to AMR and 3.57 million deaths (95% UI, 2.62-4.78) associated with AMR in 2019, the most common pathogens involved were Escherichia coli, followed by Staphylococcus auerus, klebsiella pneumonia, Streptococcus pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa. In regard to pathogen-drug combinations, an estimated 50,000 to 100,000 deaths were caused by multidrug-resistant excluding extensively drug-resistant tuberculosis, third-generation cephalosporin-resistant E coli, carbapenem-resistant A baumannii, fluoroquinolone-resistant E coli, carbapenem-resistant K pneumoniae, and third-generation cephalosporin-resistant K pneumoniae. Of note, methicillin-resistant S aureus was found to have caused more than 100,000 deaths and 3.5 million DALYs attributable to AMR in 2019.

This study was limited by the lack of available data from many low- and middle-income countries on the distribution of pathogens by infectious syndrome, the prevalence of resistance for key pathogen-drug combinations, and the number of deaths associated with infection. Other limitations included several potential sources of misclassification bias, as well as potential selection bias.

According to the researchers, “identifying strategies that can work to [decrease] the burden of bacterial AMR — either across a wide range of settings or those that are specifically tailored to the resources available and leading pathogen-drug combinations in a particular setting — is an urgent priority.”

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Murray CJL, Ikuta KS, Sharara F, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. Published online January 20, 2022. dio:10.1016/S0140-6736(21)02724-0