Jeremy Lasek – PHAA
The World Health Organization (WHO) has declared Antimicrobial Resistance (AMR) “one of the top 10 global public health threats facing humanity”. The WHO states that, “Antimicrobials – including antibiotics, antivirals, antifungals and antiparasitics – are medicines used to prevent and treat infections in humans, animals and plants.”
AMR is what occurs in microbials, including viruses and bacteria, as they adapt over time and become more difficult to treat with antimicrobial drugs. This adaptation happens naturally, but the change can be made faster due to several factors. Due to AMR, some drugs even become completely ineffective against certain microbials.
When AMR occurs, antimicrobials do not work as well, leading to a higher risk of “disease spread, severe illness and death.” AMR therefore leads to substantial burdens placed on health systems, with longer hospitalization periods and AMR-related deaths.
Comprehensive AMR study
A group of leading researchers have just published a study in The Lancet, titled ‘Global burden of bacterial antimicrobial resistance in 2019: a systemic analysis’, in what they believe are, “the most comprehensive estimates of [global] AMR burden to date.”
The Lancet report states, “We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen–drug combinations in 204 countries and territories in 2019.”
Data was obtained from a variety of sources, including hospital systems and previous literature, to help estimate the burden of AMR.
“Understanding the burden of AMR and the leading pathogen–drug combinations contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics,” the Lancet report says.
“We used predictive statistical modelling to produce estimates of AMR burden for all locations, including for locations with no data. Our approach can be divided into five broad components: number of deaths where infection played a role, proportion of infectious deaths attributable to a given infectious syndrome, proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antibiotic of interest, and the excess risk of death or duration of an infection associated with this resistance.
“Using these components, we estimated disease burden based on two counterfactuals: deaths attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and deaths associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection).
Findings
“On the basis of our predictive statistical models, there were an estimated 4.95 million deaths associated with bacterial AMR in 2019, including 1.27 million deaths attributable to bacterial AMR. In other words, if all drug-resistant infections were replaced by no infection, 4.95 million deaths could have been prevented in 2019, whereas if all drug-resistant infections were replaced by drug-susceptible infections, 1.27 million deaths could have been prevented.
“Our analysis clearly shows that bacterial AMR is a major global health problem. It poses the largest threat to human health in sub-Saharan Africa and south Asia, but it is important in all regions.
“At the regional level, we estimated the all-age death rate attributable to resistance to be 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 infections accounted for more than 1.5 million deaths associated with resistance in 2019, making it the most burdensome infectious syndrome.
Implications of all the available evidence
“Our estimates indicate that bacterial AMR is a health problem whose magnitude is at least as large as major diseases such as HIV and malaria, and potentially much larger. Bacterial AMR is a problem in all regions; we estimated that, in 2019, the highest rates of AMR burden were in sub-Saharan Africa.
“Six pathogens accounted for 73.4% of deaths attributable to bacterial AMR. Seven pathogen–drug combinations each caused more than 50,000 deaths, highlighting the importance of developing policies that specifically target the deadliest pathogen–drug combinations, particularly through expansion of infection prevention and control programmes, improving access to essential second-line antibiotics where needed, and through vaccine and antibiotic development.
“Additionally, our comprehensive data collection effort shows that high-quality data on infectious disease, pathogens, and AMR are only sparsely available in many low-income settings. Both preventing bacterial AMR and increasing microbiological laboratory and data collection capacity to improve scientific understanding of this health threat should be a very high priority for global health policy makers.”
Discussion
“The higher burden in low-resource health systems highlights the importance—both for the management of individual patients and for the surveillance of AMR—of well-developed national action plans and laboratory infrastructure in all regions and countries.
“The pattern of AMR varies geographically, with different pathogens and pathogen–drug combinations dominating in different locations. Our regional estimates could prove useful for tailoring local responses as a one size fits all approach might be inappropriate. Although antibiotic stewardship is a foundational aspect for preventing the spread of AMR, limiting access to antibiotics is not a suitable response to AMR in all settings.
“In fact, it could be argued that an increase in access to antibiotics would decrease the AMR burden in some locations where second-line antibiotics are unavailable and would be lifesaving; this might well be the case in western sub-Saharan Africa. By contrast, limiting access to antibiotics in south Asia through stewardship programs might be the appropriate response for that region because antibiotic overuse or misuse is believed to be a major driver of AMR there.
“AMR is a global problem and one that requires both global action and nationally tailored responses,” the Lancet article concludes.
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