Lancet: Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis

20 January, 2022

This new paper in The Lancet suggests bacterial antimicrobial resistance caused over a million deaths in 2019. 'If left unchecked, the spread of AMR could make many bacterial pathogens much more lethal in the future than they are today.' Citation, summary and comment from me below.

CITATION: Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis

Antimicrobial Resistance Collaborators †

The Lancet, January 19, 2022



Background: Antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications 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. To our knowledge, this study presents the most comprehensive estimates of AMR burden to date.

Methods: 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...

Findings: On the basis of our 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. 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 (20·9–35·3), and lowest in Australasia, at 6·5 deaths (4·3–9·4) per 100 000...

Interpretation: AMR is a leading cause of death around the world, with the highest burdens in low-resource settings. 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...

COMMENT (NPW): I have not had a chance to read the paper in detail, but it seems to ignore discussion on what is arguably the leading cause of antimicrobial resistance: inappropriate use. I could see only one reference to this: 'inappropriate use of antibiotics driven by insufficient regulations and ease of acquisition'. They do not mention a hugely important cause of inappropriate use: lack of availability and use of reliable information on how to select and use antibiotics, for prescribers and users. As WHO noted 10 years ago ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ There is no evidence that the situation has improved since then. As HIFA member Massimo Serventi (Tanzania) has pointed out, overprescription is also driven by perverse profit motives.

Neil Pakenham-Walsh, HIFA Coordinator,

Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines