Antimicrobial resistance a leading cause of global deaths, study shows
Antimicrobial resistance (AMR) has been found to be a leading cause of death worldwide in a study published in The Lancet.
The study is the largest to-date assessing the global impact that bacterial AMR has on patients and countries’ health systems. It found that in 2019, the deaths of 4.95 million people were associated with drug resistant bacterial infections. Of these, 1.27 million deaths were directly caused by AMR. This figure almost equals the combined deaths caused by HIV and malaria, and in terms of deaths caused by infections, AMR sits only behind Covid-19 and tuberculosis.
These figures are much higher than previous estimates which put deaths caused by AMR at 700,000 a year.
The study details the AMR burden for 23 bacterial pathogens with Escherichia coli being accountable for the most deaths — and 88 pathogen–drug combinations. Data show that meticillin-resistant Staphylococcus aureus (MRSA) was responsible for causing the highest number of deaths.
Data from the study show that the six leading pathogens for deaths associated with resistance are (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa), which were responsible for 929 ,000 deaths attributable to AMR.
The study highlights how the clinical pipeline for antibiotics is too small to combat the problem and calls on political leaders to make AMR a higher priority going forward. More so, the study calls on research efforts to be accelerated to address knowledge and innovation gaps, and to help inform policy and practices.
The researchers identified that low-resource countries were impacted the most by AMR, with western sub-Saharan Africa found to have the highest death toll.
The threat of AMR is two-fold when it comes to resistance and access to adequate antibiotics. According to Ramanan Laxminarayan, the AMR burden in sub-Saharan Africa may be partly down to inadequate access to antibiotics coupled with high infection rates. Compare this to south Asia and Latin American where access to antibiotics is good but resistance is still high and where over two-thirds of AMR-related deaths were due to resistance to first-line antibiotics.
The researchers from the study are now calling on access to effective antibiotics to be made a global priority. AMR should be seen as a worldwide problem, the study states, and should be tackled with a One Health approach. Steps needed to combat AMR include better surveillance, improved diagnostics, less oversubscribing of antibiotics, and a better antimicrobial and vaccine pipeline. Whilst these calls have been made in the past and there have been notable efforts – in particular The Global Antimicrobial Resistance and Use Surveillance System and the Fleming Fund – innovation in the area still remains slow. Vaccines are available for only one of the six leading pathogens described in the study.
The study notes that the Covid-19 pandemic may have had an adverse effect on AMR rates due to antibiotics misuse and prolonged hospital stays. The researchers point out that this fact means that actions to address AMR should be scaled up urgently.
The researchers are also calling on The Global Fund to Fight AIDS, Tuberculosis and Malaria to consider AMR as a health area to invest in. The Global Fund is holding its Seventh Replenishment meeting later this year, and with the Fund considering how best to strengthen pandemic preparedness and create resilient health systems, now is the best time for AMR to get the attention it deserves.
“The existing burden of AMR and its future threat should be an urgent stimulus to revise and widen The Global Fund’s mission. It is now time for the Fund to embrace AMR as one of its core responsibilities. And donors should invest generously in such a renewed and reinvigorated Fund,” researchers from The Lancet state.
Dr Steve Arlington, chairman of the Advisory Board, The Pistoia Alliance, a non-for-profit life science organisation, whose members include the top global pharma companies commented:
“As the report shows, antibiotic resistance is already affecting millions of patients around the world. Without coordinated international projects, the problem is only going to worsen. Global challenges like AMR require global solutions. We’ve already seen this throughout the current pandemic, where working together enabled researchers, healthcare workers and governments to make incredible scientific gains to address Covid-19.
“Yet, there are still many disease areas where very little progress has been made in the last four decades – AMR is one such area. The serious consequences of AMR have long been known, but it is yet to be tackled with any urgency. We must now see action around the world to address it. We need a renewed focus driven by public-private partnerships and funding from philanthropic organisations. Crucially, governments and international bodies must now look to incentivise research. Without a significant and prolonged increase in investment into AMR research, the cost to national economies and public health will be devastating.”