More than 39 million deaths from antibiotic-resistant infections are estimated by 2050, according to a global analysis published on Monday (16) in the renowned scientific journal The Lancet. The study by the Global Research on Antimicrobial Resistance (GRAM) Project is the first to delve into the global impacts of antimicrobial resistance on health.
THE analysis shows that more than a million people died due to antibiotic resistance worldwide between 1990 and 2021. In the period, deaths related to the condition among children under five years old decreased by 50%, while those among people aged 70 and over increased by more than 80%.
The study also makes a future prediction, indicating that deaths directly caused by antimicrobial resistance will increase steadily over the coming decades, rising by almost 70% by 2050 compared to 2022, impacting the elderly in particular. Furthermore, over the same period, deaths in which antibiotic-resistant bacteria play a role (i.e. indirect deaths) could increase by almost 75%, from 4.71 million to 8.22 million per year.
The findings highlight the need for interventions that incorporate infection prevention, vaccination, minimizing inappropriate antibiotic use and research into new antibiotics to mitigate the number of deaths caused by antimicrobial resistance predicted for 2050.
“Antimicrobial drugs are a cornerstone of modern healthcare, and the rise of resistance to them is a major cause for concern. These findings highlight that AMR has been a significant global health threat for decades and that this threat is growing. Understanding how trends in AMR deaths [resistência antimicrobiana] have changed over time and how they are likely to change in the future is vital to making informed decisions to save lives,” says study author Mohsen Naghavi, leader of the AMR research team at the Institute of Health Metrics (IHME), University of Washington, in the United States, press release.
The study produced estimates for 22 pathogens, 84 pathogen-drug combinations and 11 infectious syndromes, including meningitis, bloodstream infections and other infections. The estimates were based on 520 million individual records from a wide range of sources, including hospital data, death records and antibiotic use data.
Statistical modeling was used to produce estimates of deaths directly from antibiotic resistance and those in which the condition played a role. Based on the calculated historical trends, the authors estimated the likely global and regional health impacts of AMR from 2022 to 2050.
Estimates were also produced for scenarios in which the quality of healthcare and access to antibiotics improve in the future and drug development targets gram-negative bacteria.
What is antimicrobial resistance?
Antimicrobial resistance occurs when bacteria, viruses, fungi and parasites stop responding to medicines, making people sicker and increasing the risk of spreading disease and death.
In the case of bacteria, this phenomenon is known as antibiotic resistance and microorganisms that exhibit this resistance are called “superbugs”.
According to the World Health Organization (WHO), resistance is mostly caused by the improper and excessive use of antibiotics by patients.
Until now, no study had assessed historical trends in antimicrobial resistance, nor had it made detailed predictions of future global impacts. In 2022, a first study revealed that global deaths linked to antibiotic-resistant bacteria in 2019 were greater than deaths from HIV/AIDS or malaria, directly leading to 1.2 million deaths and contributing to another 4.95 million deaths.
Global trends
The findings reveal that more than a million lives were lost each year between 1990 and 2021 as a direct result of antimicrobial resistance. In 1990, there were 1.06 million deaths directly due to antibiotic resistance out of a wider total of 4.78 million associated deaths. In 2021, AMR directly led to 1.14 million deaths and was associated with a wider total of 4.71 million deaths.
In 2021, there was a reduction in ADR deaths compared to 2019 (1.27 million direct ADR deaths; 4.95 million associated deaths), due to reductions in the burden of non-COVID-19 respiratory infections. This is likely related to social distancing and other protective measures adopted during the pandemic. The team’s analysis suggests that this decline in ADR deaths was only temporary.
Over the three decades, trends in antimicrobial resistance deaths have undergone significant age-related changes. Deaths among children under five have decreased by more than 50%—a 59.8% reduction in direct AMR deaths, from 488,000 to 193,000 deaths; and a 62.9% reduction in AMR-related deaths, from 2.29 million to 840,000 deaths. This may be related to improvements in the delivery of infection prevention and control measures, such as vaccination, among infants and young children.
Over the same period, ADR deaths among adults aged 70 and older increased by more than 80%—an 89.7% increase in direct ADR deaths, 519,000 in 2021; an 81.4% increase in ADR-related deaths, 2.16 million in 2021. According to the researchers, this may be related to the rapid aging of the population and the greater vulnerability of older people to infection.
The regions where there was the greatest increase in deaths directly caused by antimicrobial resistance, according to the study, were Western sub-Saharan Africa, tropical Latin America, high-income North America, Southeast Asia and South Asia. According to the analysis, annual deaths increased by more than 10,000 between 1990 and 2021 in these locations.
Among the pathogens with the greatest critical importance, that is, those that pose a greater risk of death, in the study are six of the seven pathogens classified by the WHO as the most difficult to treat. This is the case of methicillin-resistant S. aureus, whose deaths increased globally from 57,200 in 1990 to 130,000 in 2021.
Among gram-negative bacteria — some of the most resistant to antimicrobial drugs — resistance to carbapenems has increased more than any other type of antibiotic, rising from 127,000 in 1990 to 216,000 in 2021.
Future projections
The authors estimate that deaths from antimicrobial resistance will rise steadily over the coming decades based on current trends. According to the study, 1.91 million annual deaths directly related to AMR are projected by 2050 — a 67.5% increase from 1.14 million deaths in 2021.
By mid-century, AMR is also expected to play a role in 8.22 million broader deaths – a 74.5% increase from the 4.71 million associated deaths in 2021. In total, between 2025 and 2050, antibiotic resistance is estimated to directly lead to more than 39 million deaths and be associated with 169 million indirect deaths from the condition.
The study says that the trends of reduction in deaths among children under five will continue, with the number falling by half in 2050 compared to 2022 — a 49.6% drop, from 204,000 to 103,000 deaths. However, other age groups will be affected by the increase in deaths from AMR, especially among the elderly over 70 — an increase of 146% by 2050, from 512,353 to 1,259,409. According to the analysis, the largest increase in this age group will occur in high-income countries.
Overall, future deaths from antimicrobial resistance will be highest in South Asia, the study found, which includes countries such as India, Pakistan and Bangladesh — a total of 11.8 million direct deaths are expected between 2025 and 2050. Deaths from the condition will also be high in other parts of South and East Asia and sub-Saharan Africa.
Ultimately, the study suggests that improving overall treatment of infections 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 prevented, respectively.
In a scenario where new antibiotics targeting gram-negative bacteria were developed, the study estimates that 11.08 million deaths attributable to antimicrobial resistance could be prevented globally over the same period.
“There has been real progress in combating AMR, particularly among young children, but our findings indicate that more needs to be done to protect people from this growing global health threat. By 2050, resistant infections could be involved in around 8 million deaths each year, either as a direct cause of death or as a contributing factor,” says Stein Emil Vollset, from the Norwegian Institute of Public Health and an affiliate professor at IHME.
“To prevent this from becoming a deadly reality, we urgently need new strategies to reduce the risk of serious infections through vaccines, new medicines, better healthcare, better access to existing antibiotics and guidance on how to use them most effectively,” he added.
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This content was originally published in Antibiotic resistance could kill more than 39 million by 2050, says study on the CNN Brasil website.
Source: CNN Brasil
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