Global burden of bacterial antimicrobial resistance

Our California trip is at T-2 days! Today, I’m going to write just a bit about the article which appears on the cover of The Lancet, Global burden of bacterial antimicrobial resistance (AMR) in 2019, a systematic analysis, by Christopher Murray from the University of Washington and colleagues. In the study, the authors 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 using predictive statistical modeling. The researchers found an estimated 4.95 million deaths associated with bacterial AMR, including 1.27 million deaths attributable to bacterial AMR. The six leading pathogens for deaths associated with resistance (E. coli, followed by S. aureus, K. pneumoniae, S. pneumoniae, A. baumannii, and P. aeruginosa) were responsible for 929,000 deaths attributable to AMR. MRSA was particularly deadly, and the authors describe data gaps in many low-income settings. There is a major need to expand microbiology lab capacity along with public health surveillance.

For anyone who has done clinical work in a low income setting, these results come as no surprise. It’s been several years since I took care of patients in Mozambique or Mexico, but I remember well patients who had MRSA or other bacterial infections and suffered from a delayed diagnosis. AMR is truly a silent emergency, even in high income settings like the United States. AMR disproportionately affects poor individuals who have little access to second-line antibiotics that could work when first-line drugs fail.

What about vaccines? Of the bacterial pathogens covered in this study, only pneumococcal pneumonia is preventable through vaccination. We need new vaccines, such as a S. aureus (and therefore MRSA) vaccine, but that won’t be happening next week.

The burden of resistance partly reflects the insufficient access to antibiotics. And the true burden of resistance could be greater than that estimated in this study, as new superbugs emerge. The editorialist concludes that leaders must take seriously the importance of addressing AMR and the challenge of access to affordable, effective antibiotics. There is work being done on AMR, such as that of Kevin Outterson and colleagues at Boston University, but much more progress needs to be made.

Like any health issue facing the world’s poor, it’s all about money. Do the lives of the poor matter as much as the lives of the rich? Where are the health equity advocates, and why aren’t we speaking out effectively, with one voice?

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