American scientists conducted a systematic analysis of 2019 data from 204 countries and territories and showed that hundreds of thousands of people die annually from common bacterial infections that were previously successfully treated with antibiotics but are now resistant to them. These primarily affect lower respiratory tract and bloodstream infections. Antibiotic resistance (AR) has already surpassed malaria and HIV/AIDS, which for many years topped the list of killer infections, as a cause of death.

The report's authors call for urgently expanding efforts to combat antibiotic resistance and demand urgent action from policymakers. Specifically, it is necessary to optimize the use of existing antibiotics, strengthen infection monitoring, and increase funding for the development of new antimicrobial agents.

The authors note that the new data reveals the true scale of the ADR problem in the modern world. While previous scenarios projected 10 million deaths due to ADR by 2050, it is now clear that the world will reach this figure much sooner.

Previously, detailed analyses of the health impact of ABRs have been conducted for several countries and regions, and a smaller number of pathogen-drug combinations have been studied for a number of other countries.

A new report from the Global Research on Antimicrobial Resistance (GRAM) analyzed deaths associated with 23 pathogens and 88 pathogen-drug combinations for 204 countries and territories during 2019. Statistical modeling methods were used to estimate the impact of ABR in all countries, including those with missing data, based on 471 million individual records from systematic reviews, hospitals, surveillance systems, and other sources.

The analysis looked at deaths directly caused by antibiotic-resistant infections (i.e., deaths that would not have occurred if the infection had been susceptible to antibiotics) and deaths indirectly caused by antibiotic resistance (i.e., deaths for which antibiotic-resistant infections were associated but not directly caused). It turned out that antibiotic-resistant infections were responsible for 1.27 million deaths and were indirectly linked to an additional 4.95 million deaths globally in 2019. Compare this to 860,000 deaths from HIV/AIDS and 640,000 deaths from malaria that year.

Antimicrobial resistance in lower respiratory tract infections, such as pneumonia, was directly responsible for more than 400,000 deaths in 2019 and was indirectly associated with more than 1.5 million deaths. Antimicrobial resistance in bloodstream infections, particularly those leading to sepsis, was responsible for 370,000 deaths in 2019 and was linked to nearly 1.5 million deaths. Intra-abdominal infections—most commonly appendicitis—due to ABR were fatal in 210,000 cases and were an indirect cause of death in another 800,000. Approximately one in five ABR-related or ABR-related deaths occurred in children under 5 years of age.

The highest incidence of deaths due to ABD was observed in sub-Saharan Africa and South Asia (24 and 22 deaths per 100,000 population, respectively). In high-income countries, ABD was the direct cause of 13 deaths per 100,000 population.

Among the 23 pathogens studied, ABR to six of them ( E. coli, S. aureus, K. pneumoniae, S. pneumoniae, A. baumannii, P. aeruginosa ) directly led to 929,000 deaths and was indirectly associated with 3.57 million deaths; methicillin-resistant Staphylococcus aureus (MRSA) alone caused more than 100,000 deaths.

More than 70% of deaths caused by ABR are associated with bacterial resistance to first- and second-line antibiotics – fluoroquinolones and beta-lactams.

As Dr. Ramanan Laxminarayan of the US-based research organization, the Center for Disease Dynamics, Economics & Policy, noted in a commentary on the GRAM report, ABI was previously a hidden problem, but now we have a clearer picture of its scale and prevalence. The number of people dying from ABI already exceeds that from HIV/AIDS. Yet, nearly $50 billion is allocated annually to HIV/AIDS research, while funding for ABI is significantly lower. This needs to change. Funds should be directed toward preventing infectious diseases, monitoring and ensuring the prudent use of existing antimicrobials, and developing new antimicrobials.

* Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis // The Lancet, 2022. doi: 10.1016/S0140-6736(21)02724-0