CLINICAL ISSUES :: AMR
The silent pandemic is no longer silent
By Diane Flayhart, MBA S
ince the introduction of penicillin in 1942, antimicrobi- als have transformed the treatment of infections and have saved millions of lives. But decades of misuse and
outdated guidelines have driven a rise in the organisms that are resistant to these lifesaving drugs. Antimicrobial resistance (AMR)—bacteria’s ability to over-
come the effects of the drugs designed to kill or disarm them—is one of the world’s greatest public health threats. Today, at least 1.27 million deaths worldwide are attributed to resistant bacte- rial infections per year, and this number is growing.1 According to the Centers for Disease Control and Prevention
(CDC), in the United States alone, more than 2.8 million antibiotic-resistant infections occur each year; in fact, some- one dies every 15 minutes from a drug-resistant infection.2 As it continues to increase rapidly across the world, AMR is
considered a “silent pandemic,” which actually threatens modern medicine. As the pathogens that cause infections become increasingly drug-resistant, common medical proce- dures—including surgery, childbirth, and chemotherapy—will become increasingly life-threatening. Put into perspective, if left unabated, the effects of AMR could be worse than COVID-19.3 Future projections suggest AMR could result in millions
of deaths and trillions of dollars in lost global production.4 A recent publication, Global burden of bacterial antimicrobial resis- tance in 2019: a systematic analysis, provided in-depth insights into the global burden of drug resistant infections. It is a com- prehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data. The paper uses several sources for the data and an estimation model to determine rates for regions that did not have complete data resources. In total, 471 million individual records or isolates covering 7585 study- location-years were used as input data to the estimation process.
The analysis assessed burden of resistance by region, as
well as by type of organism causing the infection and the source of the infection. By region, Sub-Saharan Africa had the highest burden (27.3 deaths per 100,000 attributable to AMR and 98.9 per 100,000 associated with AMR), followed by South Asia (21.5/100,000 attributable and 76.8/100,000 associated deaths). In comparison, high-income regions had an AMR- attributable death rate of 13/100,000 and an AMR-associated death rate of 55.7/100,000. The lowest regional AMR burden was in Australasia (6.5/100,000 attributable and 28.0/100,000 associated deaths).
A broad analysis of pathogens causing disease was com- There were an estimated 4.95 million (3.62–6.57) deaths associ-
ated with bacterial AMR in 2019, including 1.27 million (95% UI 0.911–1.71) deaths attributable to bacterial AMR. This data clearly demonstrates that bacterial AMR is a leading global health issue. These numbers also make AMR more deadly than such leading infectious disease threats as malaria and HIV/
AIDS.The analysis showed that AMR all-age death rates were highest in some low and low middle income countries (LMICs), making AMR not only a major health problem globally but a particularly serious problem for some of the poorest countries in the world.
pleted. There were six AMR pathogens that caused 929,000 of the 1.27 deaths attributable to AMR. The six pathogens responsible for more than 250,000 deaths associated with AMR were E coli, Staphylococcus aureus, K pneumoniae, S pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa, by order of the number of deaths. The prevalance of these pathogens, however, varied by region. In the high-income super-region, approximately half of the fatal AMR burden was linked to two pathogens: S aureus and E coli. By contrast, in sub-Saharan Africa, the leading pathogens were distinct from those of the high-income super-region, and each represented a smaller share of the AMR burden; S pneumoniae contributed to 15.9% of the deaths attributable to AMR and K pneumoniae contributed to 19.9% of the deaths attributable to AMR. Three infectious syndromes dominated the global bur-
dens attributable to and associated with AMR in 2019. The syndromes were lower respiratory and thorax infections, bloodstream infections, and intra-abdominal infections. Combined, these three syndromes accounted for 78% of deaths attributable to AMR in 2019; lower respiratory infections alone accounted for more than 400,000 attributable deaths and 1.5 million associated deaths.
Now we have the data, what are the actions we need to take In conclusion, the authors of the paper noted, understanding the burden of AMR and the leading pathogen–drug combina- tions contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection
38 MAY 2022
MLO-ONLINE.COM
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