Antibiotic resistant infections could cause more than 39 million deaths by 2050

Background

The new study by the Global Research on Antimicrobial Resistance (GRAM) Project is the first global analysis of antimicrobial resistance (AMR) trends over time.

A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts.

This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050.

Methods

The researchers estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen–drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021.

They collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. They used statistical modelling to produce estimates of AMR burden for all locations, including those with no data.

Findings

In 2021, they estimated 4.71 million deaths were associated with bacterial AMR, including 1.14 million deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location.

From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. 

Our forecasts show that an estimated 1.91 million deaths [+cc.70% over 2022] attributable to AMR and 8.22 million deaths [+cc.75% over 2022] associated with AMR could occur globally in 2050.

This could place a dramatic burden on health systems and national economies, the study's authors warned.

"We see the interaction of the diverging trends in children younger than 5 years and older adults in the projected AMR burden to 2050. Although AMR deaths increase in numbers for all ages combined, they show strong declines [...] in children younger than 5 years, but a more than a doubling globally and within five of the super-regions in individuals 70 years and older." 

According to the researchers, low-income and middle-income countries [LMICs] bear a disproportionately higher burden because these regions - sub-Saharan Africa and South Asia - have the highest rates of antibiotic resistance-related deaths, particularly from extensively drug-resistant tuberculosis.

The persistently high AMR mortality rate in sub-Saharan Africa "reflects many of the challenges that LMICs broadly face, which include fragmented health systems, inadequate intensive care units (ICU) facilities, overcrowded ICUs, staff shortages, inadequate universal access to WASH [ water, sanitation, and hygiene], few trained infection prevention and control personnel, underdeveloped microbiological capacity, and limited access to antibiotics," the authors said.

Interpretation

Our findings show the importance of infection prevention,

as shown by the reduction of AMR deaths in those younger than 5 years.

Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community.

"The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs [disability-adjusted life-years] versus number of deaths.

"Given the high variability of AMR burden by location and age,

it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics

to mitigate the number of AMR deaths that are forecasted for 2050."

"Our analysis of trends in AMR mortality by age suggests that there is a need for interventions to tackle the increasing burden of AMR in older age groups going forward. Findings from this study provide evidentiary support to policy measures that combat AMR and have the potential to save lives,

by adopting strategies that decrease risk of infections through new vaccines, improved quality of health care in hospitals and health centres, improved access to antibiotics and promotion of antibiotic stewardship.

Beatrix Oroszi, director of the Centre for Epidemiology and Surveillance at Semmelweis University, said in an interview with Portfolio that this is one of the four pandemics currently underway, which is why it is important to talk about antimicrobial resistance, or multidrug- resistant organisms.

AMR is also called a "silent pandemic". The more we use an antibiotic, the more bacteria become resistant to it. The most important thing to know about antibiotic resistance is that antibiotics cannot kill bacteria that have become resistant. Many of these bacteria have spread all over the world.

Cover image (for illustration purposes only): Getty Images