February 23, 2022
The Global Burden of Antimicrobial ResistanceBy Christopher J. Graber, MD, MPH, FIDSA
While the COVID-19 pandemic has deservedly received the most attention in global health spheres over the past two years, the rising threat of antimicrobial resistance (AMR) is also critically important to address. It has always been difficult to measure its direct impact on mortality, however, due to a lack of integrated data sources from which its effect can be determined.
In a study recently published in The Lancet, authors affiliated with the Institute for Health Metrics and Evaluation at the University of Washington addressed this gap by assiduously compiling worldwide data involving 471 million individual records or isolates from published studies, diagnostic laboratories, regional, national and global surveillance networks, and other sources, focusing on 12 major infectious syndromes, 23 bacterial pathogens, 18 drug categories, and 88 pathogen-drug combinations for the calendar year 2019. These data were entered into an estimation model where two scenarios were explored: burden of resistant infections versus drug-susceptible infections (directly attributable to AMR) and resistant infections versus no infections at all (associated with AMR).
The authors estimated that 1.27 million deaths (95% uncertainty interval [UI], 0.911-1.71 million) in 2019 were directly attributable to AMR, with 4.95 million deaths (UI, 3.62-6.57 million) associated with AMR. Sub-Saharan Africa had the highest all-age death rate attributable to and associated with AMR despite having the lowest percentage of resistant versus susceptible infection. Resistance in Staphylococcus aureus and Escherichia coli were responsible for approximately half of the fatal AMR burden in high-income regions, while resistance in Streptococcus pneumoniae and Klebsiella pneumoniae were the largest contributors in sub-Saharan Africa.
This work provides an important snapshot of the impact of AMR on global mortality, estimating a higher impact than many other diseases, including HIV and malaria. The data compiled are essential in highlighting the need to devote resources to reducing AMR through antimicrobial development and stewardship, vaccination, infection control, sanitation, and other modalities, and they provide specificity as to where and how those resources should be devoted.
