INFECTION CONTROL
Targeting global threats presented by sepsis and antimicrobial resistance
Sepsis improvement programmes have received criticism in recent years, with some claiming that they have resulted in increased hospital antimicrobial consumption. But should we be targeting sepsis management or should we be looking elsewhere for solutions, including better integration of diagnostics? Louise Frampton reports.
Earlier this year, an analysis of 204 countries and territories revealed that antimicrobial resistance (AMR) is now a leading cause of death worldwide, higher than HIV/AIDS or malaria. It showed that more than 1.2 million people – and potentially millions more – died in 2019 as a direct result of antibiotic-resistant bacterial infections. Published in The Lancet,1
the report
highlighted an urgent need to scale up action to combat AMR, and outlined immediate actions for policymakers to help save lives and protect health systems. These included optimising the use of existing antibiotics, taking greater action to monitor and control infections, and providing more funding to develop new antibiotics and treatments. Of the 23 pathogens studied, drug
resistance in six alone (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa) led directly to 929,000 deaths and was associated with 3.57 million. One pathogen-drug combination – methicillin-resistant S. aureus (MRSA) – directly caused more than 100,000 deaths in 2019, while six more each caused between 50,000 and 100,000 deaths. Across all pathogens, resistance to two classes of antibiotic often considered the first- line defence against severe infections – fluoroquinolones and beta-lactam antibiotics – accounted for more than an estimated 70% of deaths caused by AMR.
Ongoing research Methicillin-resistant Staphylococcus aureus directly caused more than 100,000 deaths in 2019. 22
The health impact of pathogens varied widely based on location, with deaths attributable to AMR in sub-Saharan Africa most often caused by Streptococcus pneumoniae (16% of deaths) or K. pneumoniae (20%), while around half of deaths attributable to AMR in high-income countries were caused by Staphylococcus aureus (26%) or E. coli (23%).1 “Previous estimates had predicted 10 million annual deaths from antimicrobial resistance by 2050, but we now know for certain that we are already far closer to that figure than we thought. We need to leverage this data to course-correct action and drive innovation if we want to stay ahead in the race against antimicrobial resistance,” commented study co-author Professor Chris Murray, of the Institute for Health Metrics and Evaluation at the University of Washington, USA.1 Research also suggests that AMR may have been exacerbated during the pandemic. An analysis of antimicrobial resistance at more than 270 US
SEPTEMBER 2022
WWW.PATHOLOGYINPRACTICE.COM
CDC/Melissa Dankel
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