A systematic review published recently by the Antimicrobial Resistance Collaborators reveals the global burden of antimicrobial resistance (AMR) is far greater than the 700,000 deaths per year estimated by WHO and the UN, and makes the predicted ‘10 million deaths due to AMR by 2050’ (and its economic impact) a far more believable scenario.
In their extensive review, the Antimicrobial Resistance Collaborators used predictive statistical modelling, and pulled data from 471 million records or isolates that covered 204 countries to estimate AMR burden across the world. Their model tells a very interesting story of the AMR burden.
the total global burden of AMR in 2019 was 4.95 million deaths
Perhaps the ‘headline’ of the review is that the total global burden of AMR in 2019 (i.e. pre-COVID) was 4.95 million deaths – and 1.27 million of these were from bacterial AMR alone. If you compare this figure to the approximate 5.9 million deaths worldwide from COVID (2019 to the present date – data from Google), the annual burden of AMR is double. Despite this, the responses to COVID and AMR have been markedly different.
The systematic review goes on to show that the AMR burden, as with many infectious diseases, is not evenly distributed across the world: Western sub-Saharan Africa has the highest death rate, whilst Australasia has the lowest. The below Figure is taken from the systematic review and shows where the burden is heaviest geographically.
Whilst the models show that sub-Saharan Africa bears a higher AMR burden, actual data and papers covering this region and indeed the whole of Africa are scarce. An initiative to counter that is the Special Collection edited by Dr Alaa AbouElfetouh (Alexandria University, Egypt) on combatting AMR in Africa through surveillance and capacity building.
Connected to the regional variation is the relationship between wealth and AMR, with poverty increasing the incidence of AMR death. A recent Review by Teagan King and colleagues published in Antimicrobial Resistance and Infection Control looked at poverty as a risk factor for infection with antimicrobial resistant microorganisms in Canada, and found infection rates increased dramatically based on income – even within the same country. For instance, infection with methicillin resistance Staphylococcus aureus (MRSA) decreases by 73% for each $100,000 increase in income.
Going back to the Antimicrobial Resistance Collaboration’s paper, they highlight that globally there were six main pathogens that accounted for 73% of all bacterial AMR attributed deaths and 75% of all the AMR associated deaths in 2019. These are: E. coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Drug resistance in these pathogens is a major health concern and more resources should be put into research, alternative therapeutics and healthcare capacity building around these specific pathogens. Targeting these six pathogens would dramatically decrease the AMR burden.
The Antimicrobial Resistance Collaboration put forward 5 steps for reducing the AMR burden:
- Infection prevention and control in both community and health-care settings
- Prevention through vaccine development and administration
- Reducing exposure to antibiotics that are not related to human health (e.g. those use in farming)
- Reduce the use of antibiotics in humans when they are not necessary (e.g. in treating viral infections).
- Allocating resources to the development of new antimicrobials
My personal view is that it is the responsibility of governments to take the lead in addressing the threat of AMR. However, it is also the responsibility of everyone to do what they can – even if it is simply finishing the course of antibiotics that have been prescribed to them.