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An image depicting aggressive bacteria

A new study led by the Oxford Global Burden of Disease Group based at the BDI provides the most comprehensive estimate to date of the global impact of antimicrobial resistance (AMR). The Global Research on Antimicrobial Resistance (GRAM) report, published today in The Lancet, estimates that more than 1.2 million people died in 2019 as a direct result of antibiotic-resistant bacterial infections, although this figure could be much higher.

AMR occurs when bacteria, viruses, fungi and parasites evolve and no longer respond to antibiotics. This means that historically treatable illnesses, such as pneumonia, hospital-acquired infections, and foodborne ailments, now kill hundreds of thousands of people every year.

Estimates of the health impacts of AMR have been published for several countries and regions, and for a small number of pathogen-drug combinations in a wider range of locations. However, until now no estimates have covered all locations and a broad range of pathogens and drug combinations.

The new GRAM report estimates deaths linked to 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019. Statistical modelling was used to produce estimates of the impact of AMR in all locations – including those with no data – using 471 million individual records obtained from systematic literature reviews, hospital systems, surveillance systems, and other data sources.

Disease burden was estimated in two ways: deaths caused directly by AMR (i.e. deaths that would not have occurred had the infections been drug-susceptible and therefore more treatable), and deaths associated with AMR (i.e. where a drug-resistant infection was implicated in deaths, but resistance itself may or may not have been the direct cause).

Key findings:

  • AMR was directly responsible for an estimated 1.27 million deaths worldwide, and associated with an estimated 4.95 million deaths, in 2019. In comparison, HIV/AIDS and malaria caused an estimated 860,000 and 640,000 deaths, respectively, in 2019 .
  • Drug-resistance in lower respiratory infections – such as pneumonia – had the greatest impact on AMR disease burden, causing more than 400,000 deaths and associated with more than 1.5 million deaths.
  • Drug resistance in bloodstream infections – which can lead to the life-threatening condition sepsis – directly caused around 370,000 deaths and was associated with nearly 1.5 million deaths. Drug resistance in intra-abdominal infections – commonly caused by appendicitis – led directly to around 210,000 deaths and was associated with around 800,000 deaths.
  • While AMR poses a threat to people of all ages, young children were found to be at particularly high risk, with around one in five deaths attributable to AMR occurring in children aged under five years.
  • Deaths caused directly by AMR were estimated to be highest in Sub-Saharan Africa and South Asia, at 24 deaths per 100,000 population and 22 deaths per 100,000 population, respectively. In high-income countries, AMR led directly to 13 deaths per 100,000.
  • Out of the seven deadliest drug-resistant bacteria, vaccines are only available for two (Streptococcus pneumoniae and Mycobacterium tuberculosis).
  • Whilst all seven of the deadliest bacteria have been identified as ‘priority pathogens’ by the World Health Organization (WHO), only S. pneumoniae and M. tuberculosis have so far been a focus of major global health intervention programmes.

The report highlights an urgent need to scale up action to combat AMR, and outlines immediate actions for policymakers that would help save lives and protect health systems. These include rapid investment in new treatments, improved infection control measures, and optimised use of antibiotics.

The GRAM leadership team Professor Christiane Dolecek (Centre for Tropical Medicine and Global Health, Oxford University), Dr Catrin Moore (BDI), and Professor Benn Sartorius  (Centre for Tropical Medicine and Global Health, Oxford University), commented: ‘Being able to measure AMR, and compare it with other major health threats, is essential to addressing its serious consequences. This work incorporates the best available data and provides reliable evidence describing the substantial mortality and morbidity caused by AMR globally. We anticipate that policymakers will use these results as we intended them, to drive action.’

The findings of the paper will be presented at an online event that will take place on Friday 4 February, 17:00 – 18:30 GMT. The launch will consist of a presentation of the paper’s key findings, an expert panel discussion and a Q&A. Register.


Image contents:  Fluoroquinolone-resistant Escherichia coli (2019) (Source: Lancet)

Image contents:  Fluoroquinolone-resistant Escherichia coli (2019) (Source: Lancet)