![]() ![]() These same six pathogens were responsible for 3.57 million (72%) of the 4.95 million deaths (95% UI, 3.62 million to 6.57 million) that were associated with AMR. Of the 1.27 million deaths (95% uncertainty interval, 0.911 million to 1.71 million) directly attributable to AMR, the study estimated 929,000 (73%) were caused by six pathogens: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. "The question is what happens if you remove all resistant bacteria? Do all those infections just disappear, or are they replaced by susceptible infections?" explained study co-author Kevin Ikuta, MD, a clinical fellow at IHME. ![]() For associated deaths, they considered an alternative scenario in which all drug-resistant infections were replaced by no infection. To estimate deaths that were directly attributable to a resistant pathogen, they considered a scenario in which those infections were replaced by susceptible infections. Naghavi and his colleagues estimated the AMR burden using two counterfactual scenarios. "We had a good background and data for mortality by cause, but 4 years ago we decided to calculate the pathogens, and the effect of antimicrobial resistance on the burden of disease," he said. Mohsen Naghavi, PhD, MPH, a professor of health metrics sciences at IHME and one of the lead authors on the study, says they've been working on the GRAM project, which builds on death and incidence estimates developed for the IHME Global Burden of Disease study, for several years. Overall, the investigators obtained 471 million individual records to estimate, through statistical modeling, the disease burden associated with and attributable to AMR for 12 major infectious syndromes for all regions of the world, including countries with no data. ![]() The study, led by researchers with Oxford University's Big Data Institute and the University of Washington's Institute for Health Metrics and Evaluation (IHME), used data from a variety of sources, including previously published studies, hospitals, diagnostic laboratories, national surveillance systems, research institutes, and clinical trials. "Our findings…clearly show that drug resistance in each of these leading pathogens is a major global health threat that warrants more attention, funding, capacity building, research and development, and pathogen-specific priority setting from the broader global health community," the authors wrote. While previous studies have looked at AMR-attributable and -associated deaths in certain regions and for certain drug-pathogen combinations, this is the first to provide a global picture of the impact of a broad range of drug-resistant pathogens. Roughly 1 in 5 of deaths linked to resistance were in children under 5. Most of the deaths were caused by six bacterial pathogens, the GRAM report found, and the burden of AMR mortality was highest in low- and middle-income countries, with sub-Saharan Africa and South Asia having the highest attributable death rates from resistant pathogens. The findings were published this week in The Lancet. ![]() Only ischemic heart disease and stroke accounted for more deaths that year. That makes AMR more deadly than such leading infectious disease threats as malaria and HIV/AIDS. Using data from 204 countries and territories on 23 bacterial pathogens and 88 drug-pathogen combinations, the Global Research on Antimicrobial Resistance (GRAM) report estimated that 1.27 million deaths in 2019 were directly attributable to a drug-resistant infection, out of 4.95 million deaths that were associated with AMR. In the largest and most comprehensive study to date on the global burden of antimicrobial resistance (AMR), an international team of researchers estimates that more than 1.2 million people died from drug-resistant infections in 2019. ![]()
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