Antibiotic-Resistant Mortality Higher Than HIV/AIDs or Malaria

A new global analysis published today estimates that antimicrobial resistance (AMR) was the leading cause of death worldwide in 2019. Investigators estimated that resistance itself caused 1.27 million deaths in 2019, and that antimicrobial-resistant infections played a role in 4.95 million deaths.

In comparison, mortality for HIV/AIDS and malaria have been estimated to be 860,000 and 640,000 deaths, respectively that same year.

The analysis was published in The Lancet.

“These new data reveal the true scale of antimicrobial resistance worldwide, and are a clear signal that we must act now to combat the threat. Previous estimates had predicted 10 million annual deaths from antimicrobial resistance by 2050, but we now know for certain that we are already far closer to that figure than we thought,” study co-author Professor Chris Murray, of the Institute for Health Metrics and Evaluation at the University of Washington, said. “We need to leverage this data to course-correct action and drive innovation if we want to stay ahead in the race against antimicrobial resistance.”

The analysis was part of the Global Research on Antimicrobial Resistance (GRAM) report that estimated deaths linked to 23 pathogens and 88 pathogen-drug combinations. The investigators looked at 204 countries and territories, and used statistical modeling to produce estimates of the impact of AMR in all locales.

Geographically, direct AMR mortality was believed to be the highest in both Sub-Saharan Africa (24 deaths per 100,000 population) and South Asia (22 deaths per 100,000 population), and AMR associated deaths were 99 per 100,000 in Sub-Saharan Africa and 77 per 100,000 in South Asia.

One of the leading causes was previously treatable infections (e.g lower respiratory and bloodstream infections) because of antibiotic-resistance. Drug resistance in 6 pathogens including E. coli, S. aureus, K. pneumoniae, S. pneumoniae, A. baumannii, and P. aeruginosa led directly to 929,000 deaths and was associated with 3.57 million. Methicillin-resistant S. aureus (MRSA) directly caused more than 100,000 deaths in 2019.

Across all pathogens, resistance to 2 classes of antibiotics (fluoroquinolones and beta-lactams), which are often the first line treatment against severe infections, accounted for more than an estimated 70% of deaths caused by AMR.

“With resistance varying so substantially by country and region, improving the collection of data worldwide is essential to help us better track levels of resistance and equip clinicians and policymakers with the information they need to address the most pressing challenges posed by antimicrobial resistance,” study co-author Professor Christiane Dolecek, GRAM scientific lead based in Oxford University’s Centre for Tropical Medicine and Global Health and the Mahidol Oxford Tropical Medicine Research Unit, said. “We identified serious data gaps in many low-income countries, emphasizing a particular need to increase laboratory capacity and data collection in these locations.”

GRAM is a project of the University of Oxford Big Data Institute–IHME Strategic Partnership, and gets support from the United Kingdom Department of Health’s Fleming Fund, the Wellcome Trust, and the Bill & Melinda Gates Foundation.

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