Antimicrobial resistance
reduction in deaths linked to AMR, 2.29 million to 840,00 deaths). This decline coincided with major improvements in the delivery of infection prevention and control measures – such as vaccination programmes – among infants and young children. However, the proportion of infectious deaths caused directly by AMR increased by a relative 13.6% – to a total of 7.2% in 2021 – among children under five years between 1990 and 2021.
Over the same period, AMR deaths among adults 70 years or older increased by more than 80% (89.7% increase in direct AMR deaths, 519,000 in 2021; 81.4% increase in deaths linked to AMR, 2.16 million in 2021), due to rapidly ageing populations and older people’s greater vulnerability to infection. Deaths directly from AMR increased most in five global regions, where annual deaths rose by more than 10,000 between 1990 and 2021: western sub-Saharan Africa, Tropical Latin America, high-income North America, Southeast Asia, and South Asia. “The fall in deaths from sepsis and AMR among
young children over the past three decades is an incredible achievement. However, these findings show that while infections have become less common in young children, they have become harder to treat when they occur. Further, the threat to older people from AMR will only increase as populations age. Now is the time to act to protect people around the world from the threat posed by AMR,” said study author Dr. Kevin Ikuta of the University of California Los Angeles (UCLA) and affiliate professor at IHME.
Different pathogens The findings reveal increasing resistance to critically important antimicrobials, with all but one of seven key pathogens rated by the WHO as the most difficult to treat leading to more deaths in 2022 compared to 1990. Deaths due to methicillin-resistant S. aureus
(MRSA) increased the most globally, leading directly to 130,000 deaths in 2021 – more than doubling from 57,200 in 1990. Among Gram- negative bacteria (some of the most resistant to antimicrobial drugs), resistance to carbapenems increased more than any other type of antibiotic, from 127,000 in 1990 to 216,000 in 2021.
Future projections The authors estimate that AMR deaths will increase steadily in the coming decades based on current trends, with 1.91 million annual deaths directly due to AMR projected by 2050 – a 67.5% increase on the 1.14 million deaths in 2021. By the middle of the century, AMR is also projected to play a role in a broader 8.22 million deaths – an increase of 74.5% on the 4.71 million associated
antibiotics, and guidance on how to use them most effectively,” said study author, Dr. Stein Emil Vollset of the Norwegian Institute of Public Health and affiliate professor at IHME. Writing in a linked comment, Professor
Samuel Kariuki, of the Kenya Medical Research Institute, who was not involved in the study, said: “The model successfully evaluated the changing trends in AMR mortality across time and location that is necessary to understand how the burden of AMR is developing, and to provide evidence for action by all stakeholders to make informed decisions regarding interventions.” Professor Kariuki concluded, by adding:
deaths in 2021. In total, between 2025 and 2050, it is estimated AMR will lead directly to more than 39 million deaths and be associated with a broader 169 million deaths. Deaths among children under five years old will continue to decline, halving in 2050 compared to 2022 (49.6% decline, 204,000 to 103,000 deaths), but these will be outpaced by increases in other age groups, particularly those aged 70 years and older (146% increase by 2050, from 512,353 to 1,259,409). There will be considerable differences globally, with a 72% increase in deaths among people 70 years and older in high-income countries compared to a 234% increase in North Africa and the Middle East. Future deaths from AMR will be highest in
South Asia – which includes countries such as India, Pakistan, and Bangladesh – where a total of 11.8 million deaths directly due to AMR are forecast between 2025 and 2050. Deaths from AMR will also be high in other parts of southern and eastern Asia and sub-Saharan Africa. The team’s modelling of alternative future scenarios reveals improving overall infection care and access to antibiotics could prevent 92 million deaths between 2025 and 2050. The greatest benefits would be in South Asia, sub- Saharan Africa, and parts of Southeast Asia, East Asia, and Oceania, with 31.7 million, 25.2 million, and 18.7 million deaths averted, respectively. Under the scenario in which new antibiotics targeting Gram-negative bacteria were developed, estimates indicate 11.08 million AMR- attributable deaths could be averted globally over the same period. “There has been real progress in tackling AMR, particularly among young children, but our findings indicate more must be done to protect people from this growing global health threat. By 2050, resistant infections could be involved in some eight million deaths each year, either as the direct cause of death or as a contributing factor. To prevent this from becoming a deadly reality, we urgently need new strategies to decrease the risk of severe infections through vaccines, new drugs, improved healthcare, better access to existing
“These data should drive investments and targeted action towards addressing the growing challenge of AMR in all regions.”
Government action In 2019, the UK published its 20-year vision for AMR.3
This set the ambitious goal of
ensuring AMR will be controlled and contained by 2040. To deliver on this vision, the government committed to producing a series of five- year national action plans. These will provide sustained and ongoing progress towards achieving the vision’s ambitions for change. The first five-year national action plan for
antimicrobial resistance, ‘Tackling antimicrobial resistance 2019 to 2024’, was an important step towards achieving this vision.4
The work carried
out across government led to progressive action towards reducing the negative impact of AMR in the UK and globally. Successes of that plan included: l Further reductions in the use of antibiotics in food-producing animals.
l The development of improved surveillance systems.
l The piloting of new payment schemes for antibiotics on the NHS.
The latest national action plan (NAP), ‘Confronting antimicrobial resistance 2024 to 2029’,5
builds on the achievements and
lessons of the first. It contains outcomes and commitments that will make progress towards the 20-year vision for AMR to be contained, controlled and mitigated. To confront AMR, the 2024 to 2029 national action plan has nine strategic outcomes organised under four themes. Action will be taken across all sectors (human health, animal health, agriculture and the environment).
Theme 1 - Reducing the need for, and unintentional exposure to, antimicrobials This theme has three outcomes: 1. Infection prevention and control and
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