Antimicrobial resistance (AMR) contributes to almost 5 million deaths a year worldwide, according to an analysis based on 23 pathogens in 204 countries.

The analysis used predictive statistical models to calculate that, “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”.

Deaths attributable to AMR were highest in western sub-Saharan Africa (27.3 per 100,000) and lowest in Australasia (6.5 per 100,000). 

Lower respiratory tract infections imposed the greatest burden overall, accounting for more than 400,000 attributable deaths and 1.5 million associated deaths.

The six leading pathogens associated with AMR (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa) were responsible for 929,000 attributable deaths and some 3.6 million associated deaths.

The analysis considered 88 combinations of pathogens and antibiotics. Methicillin-resistant S. aureus remains the most important, responsible for more than 100,000 deaths a year. Six combinations of pathogen and antibiotic each caused between 50,000 and 100,000 deaths.

Understanding the AMR burden and the most important combinations of pathogen and antibiotics “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 authors comment. 

“The pandemic has highlighted the importance of global collaboration: political leaders, the healthcare community, the private sector and the public working together to tackle a global health threat,” commented Tim Jinks of the Wellcome Trust.

“Like with Covid-19, we know what needs to be done to address AMR, but must now come together with a sense of urgency and global solidarity if we are to be successful.”

(LancetDOI: 10.1016/S0140-6736(21) 02724-0)