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.
A comprehensive estimate of the global impact of antimicrobial resistance (AMR), covering 204 countries and territories and published in The Lancet, has found that 1.27 million people died in 2019 as a direct result of AMR, which is now a leading cause of death worldwide, higher than HIV/AIDS or malaria.
Key Findings on antimicrobial resistance (AMR)
- Apart from 12.7 lakh deaths caused directly by AMR (these would not have occurred had the infections been drug-susceptible), another 49.5 lakh deaths were associated with AMR (a drug-resistant infection was implicated, but resistance itself may or may not have been the direct cause of death).
- HIV/AIDS and malaria were estimated to have caused 8.6 lakh and 6.4 lakh deaths respectively in 2019.
- Of the 23 pathogens studied, drug resistance in six (E coli, S aureus, K pneumoniae, S pneumoniae, A baumannii, and P aeruginosa) led directly to 9.29 lakh deaths and was associated with 3.57 million.
- 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.
- 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.
- One pathogen-drug combination – methicillin-resistant S aureus, or MRSA – directly caused more than 1 lakh deaths.
- Resistance to two classes of antibiotics often considered the first line of defence against severe infections – fluoroquinolones and beta-lactam antibiotics – accounted for more than 70% of deaths caused by AMR.
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.
- 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”
- 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.
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