Generated Summary
This study presents a comprehensive analysis of the global burden of bacterial antimicrobial resistance (AMR) from 1990 to 2021, with forecasts extending to 2050. The research employs a systematic approach, leveraging the Global Burden of Disease (GBD) study framework to estimate deaths and disability-adjusted life-years (DALYs) associated with and attributable to AMR across 204 countries and territories. The methodology involved collecting data from multiple sources, including mortality records, hospital discharge data, microbiology data, and various surveillance systems. Statistical modeling was utilized to produce estimates for all locations, incorporating data from 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes. The study’s approach encompassed the estimation of five key components: sepsis deaths, infectious syndrome deaths, pathogen-specific deaths, antibiotic resistance percentages, and excess risk associated with resistance. Using these components, disease burden attributable to and associated with AMR was estimated, with ‘attributable’ defined by a counterfactual of drug-susceptible infections and ‘associated’ defined by no infection. Furthermore, global and regional forecasts were generated for three scenarios: a reference scenario (most likely future), a Gram-negative drug scenario (targeting drug development), and a better care scenario (improving healthcare access). The analysis provides insights into changing trends and the need for interventions to address the increasing AMR burden.
Key Findings & Statistics
- In 2021, an estimated 4.71 million (95% UI 4.23–5.19) deaths were associated with bacterial AMR, including 1.14 million (1.00–1.28) deaths attributable to bacterial AMR.
- From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years but increased by over 80% for adults 70 years and older.
- Globally, deaths with sepsis decreased from 16.5 million (95% UI 15.7–17.3) in 1990 to 14.1 million (13.2–15.1) in 2019, then increased to 21.4 million (20.3–22.4) in 2021.
- In children younger than 5 years, sepsis deaths decreased by more than 60% from 7.69 million (7.16–8.22) in 1990 to 2.68 million (2.19–3.18) in 2021.
- In people 5 years and older, sepsis deaths more than doubled from 8.81 million (8.30–9.32) in 1990 to 18.7 million (17.8–19.6) in 2021.
- In 1990, there were 1.06 million deaths attributable to AMR and 4.78 million deaths associated with AMR.
- In 2019, AMR mortality increased to 1.20 million attributable deaths and 4.94 million associated deaths.
- In 2021, 1.14 million deaths attributable to AMR and 4.71 million deaths associated with AMR occurred.
- The global all-age mortality rate attributable to AMR decreased from 19.8 deaths per 100,000 in 1990 to 14.5 deaths per 100,000 in 2021.
- The percentage of deaths with sepsis associated with AMR increased from 29% in 1990 to 35% globally in 2019, before decreasing to 22% in 2021.
- The global number of DALYs attributable to AMR decreased between 1990 (60.9 million) and 2021 (42.6 million).
- The global all-age rate of DALYs attributable to AMR decreased from 1140 per 100,000 population in 1990 to 539 per 100,000 population in 2021.
- Children younger than 5 years had a more than 50% reduction in both attributable (60.4%) and associated (63.3%) AMR mortality from 1990 to 2021.
- Adults 70 years and older experienced a more than 80% increase in both attributable (89.5%) and associated (81.3%) mortality over the same period.
- In 2021, there were 193,000 deaths attributable to AMR in children younger than 5 years, a decrease from 488,000 in 1990.
- In 2021, there were 840,000 AMR-associated deaths in children younger than 5 years globally, compared with 2.29 million in 1990.
- For people 5 years and older, there were 948,000 deaths attributable to AMR and 3.87 million associated with AMR in 2021, both increasing from 570,000 attributable and 2.49 million associated AMR deaths in 1990.
- The fraction of deaths with sepsis attributable to AMR increased in all age groups, with an 18.0% increase in children younger than 5 years and a 35.9% increase in people 5 years and older from 1990 to 2019.
- AMR attributable deaths decreased in seven regions and increased in 14 regions between 1990 and 2021.
- MRSA was the pathogen-drug combination with the largest increase in attributable burden from 1990 to 2021.
- In 2050, there will be 1.91 million annual deaths attributable to AMR globally and 8.22 million annual deaths associated with AMR.
- Cumulatively from 2025 to 2050, the reference scenario forecasts 39.1 million deaths attributable to AMR and 169 million deaths associated with AMR.
- The global AMR all-age mortality rate is forecasted to increase from 14.2 per 100,000 in 2022 to 20.4 per 100,000 in 2050.
- Under the better care scenario, a total of 92.0 million cumulative deaths would be averted between 2025 and 2050.
- Under the Gram-negative drug scenario, 11.1 million cumulative AMR deaths would be averted between 2025 and 2050.
Other Important Findings
- The study found that despite a decrease in global sepsis mortality, the global mortality from AMR increased slightly from 1990 to 2019, followed by a slight reduction during the COVID-19 pandemic.
- The largest increases in deaths attributable to AMR from 1990 to 2021 occurred in the following super-regions: Western sub-Saharan Africa, Tropical Latin America, High-income North America, Southeast Asia, and South Asia.
- In children younger than 5 years, the pathogens with the largest number of deaths attributable to AMR in 2021 were *K pneumoniae, S pneumoniae*, and *E coli*.
- The pathogen-drug combination with the largest increase in attributable burden globally was meticillin-resistant *S aureus* (MRSA).
- In the Gram-negative drug scenario, the burden from carbapenem resistance is forecasted to continue to rise.
Limitations Noted in the Document
- The study acknowledges limitations in the historical estimates, including data availability and quality.
- The forecast models were produced from estimates of deaths due to resistance overall, which could lead to reduced accuracy if there is substantial heterogeneity across pathogen time trends.
- The forecast models do not include the outbreak of new resistant pathogens or superbugs.
- The study’s estimates may be affected by selection bias in passive microbial surveillance data and biases introduced by low rates of diagnostic culture utilization.
- The study acknowledges the potential effect of selection bias in passive microbial surveillance data, bias introduced by low rates of diagnostic culture utilisation, while differences in antimicrobial usage between private and public health-care sectors might lead to incomplete representation of AMR patterns.
- The study acknowledges that there might be methodological assumptions due to data scarcity.
- The scarcity of data from some LMICs on the distribution of pathogens by infectious syndrome, the relative risk of resistance for key pathogen-drug combinations, and the number of deaths related to infections, may affect the findings.
- The study faces unique challenges specific to time trend analysis of AMR, including the uneven temporal distribution of available data from various regions and countries, which complicates the accurate representation of global, regional, and national AMR dynamics.
Conclusion
The study highlights the critical importance of infection prevention and control measures, vaccination, and improving access to antibiotics in reducing AMR burden. The study also emphasizes the need for interventions to address the rising AMR burden in older adults, where mortality has increased significantly. The contrasting trends in AMR mortality by age underscore the importance of age-specific interventions. The study underscores that, the number of deaths averted under the better care scenario, focused on improving the management of severe infections and expanding access to antibiotics, is substantially larger than the projected gains from the Gram-negative drug scenario focused on new drug development. It emphasizes the challenges in implementing evidence-based measures, such as monitoring and evaluation plans, and the need for continuous multisectoral engagement in the fight against AMR. The study’s findings also highlight the significant increase in the burden of carbapenem-resistant Gram-negative organisms, underscoring the urgent need for research into prevention measures and treatment strategies. The study concludes by emphasizing the need for investment in drug development, infection prevention, improved healthcare quality, and accessible diagnostic tools to address the growing AMR challenge. The need for further research, particularly in areas with data scarcity, and ongoing monitoring of progress towards the 10-20-30 targets are also emphasized. The study’s projections highlight the urgent need for action, with the potential to avert millions of deaths through comprehensive strategies that address the multiple facets of AMR, underscoring the importance of a multifaceted approach to tackling this global health crisis.