Study on global AMR burden published in The Lancet

Study on global AMR burden published in The Lancet

  • 21/01/2022

At least 1.27 million deaths per year are directly attributable to AMR, says a new study published in The Lancet, which analyzed the total global burden that was caused by AMR in 2019.

Previous publications on antimicrobial resistance have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen–drug combinations in select locations. In the new study, undertaken by Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen–drug combinations were assessed for a total of 204 countries and territories in 2019. Data was gathered from systematic literature reviews, hospital systems, surveillance systems, and other sources, covering 471 million individual records or isolates and 7585 study-location-years. Predictive statistical modelling was applied to produce estimates of AMR burden for all locations, including for locations with no data. Five different parameters were used to estimate the disease burden: the number of deaths where infection played a role, the proportion of infectious deaths attributable to a given infectious syndrome, the 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.

The analysis was then based on two counterfactuals: the number of deaths attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and the number of deaths associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection). 95% uncertainty intervals were generated for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. Final estimates were displayed as aggregated to the global and regional level.

The key message of the report is that on the basis of the predictive statistical models, there were an estimated 4.95 million (3.62–6.57) deaths associated with bacterial AMR in 2019, including 1.27 million (95% UI 0.911–1,71) deaths attributable to bacterial AMR. Furthermore, the six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for 929 000 (660 000–1 270 000) deaths attributable to AMR and 3.57 million (2.62–4.78) deaths associated with AMR in 2019.

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