More than a million people died from superbugs in 2019 - this is almost double previous estimates of the death toll from untreatable infections, a review has found. A study of data from 204 countries shows that 1.27 million people died from antimicrobial resistance (AMR) in 2019. A previous, widely cited review led by former Goldman Sachs chief Lord Jim O’Neill and published in 2016 estimated that superbugs killed 700,000 people a year.
The latest study, published by a team of international researchers in the Lancet, showed that sub Saharan Africa and south Asia had the highest burden of disease. There were 225,000 deaths in Sub Saharan Africa and 389,000 deaths in South Asia - although the rate was higher in Sub Saharan Africa. The review, by the Global Research on Antimicrobial Resistance project, found that high income countries have “alarmingly high levels” of AMR burden with E. coli, which most commonly causes kidney infections, and Staphylococcus aureus, a hospital acquired infection, the most significant.
The paper highlighted how once treatable diseases such as respiratory tract infections, bloodstream infections and stomach bugs are now killing hundreds of thousands of people a year. Dr Tim Jinks, an AMR expert at Wellcome, one of the organisations that funds the project, said the paper was the most comprehensive study of the burden of AMR globally ever undertaken.
“The paper shows that the disease burden is nearly double what we anticipated. This means the problem is more urgent than we had understood,” he said. The paper found that while more than a million deaths could be directly attributed to AMR a further 4.95 million deaths were associated with superbugs. This means that if someone were being treated for cancer but caught an untreatable infection their death would be recorded as a cancer death but AMR would have been a major factor, said Dr Jinks.
Taking the 4.95m figure into account, AMR would have been the third leading cause of death in 2019, after heart disease and stroke, the paper found. Dame Sally Davies, the UK Special Envoy on Antimicrobial Resistance, said: “AMR is already one of the greatest challenges facing humanity. Behind these new numbers are families and communities who are tragically bearing the brunt of the silent AMR pandemic. We must use this data as a warning signal to spur on action at every level.” Resistance to common antibiotics such as penicillin, often considered a first line treatment for severe infections was common, the review found, accounting for more than 70 per cent of deaths attributable to AMR.
Researchers say this highlights the desperate need for new antibiotics - between 1980 and 2000 63 new antibiotics were approved for use, while comparison, between 2000 and 2018 just 15 were approved. There are just two vaccines against the seven deadliest drug-resistant infections - defined as priority infections by the WHO. But while vaccines and antibiotics are vital other interventions are also important. These include preventing overuse and misuse of drugs and ensuring they are not used inappropriately in animals, for example to promote growth.
Dr Jinks said the reasons for high rates differed around the world. In low income countries high rates of AMR could be put down to “antibiotic usage, the resilience of healthcare systems, the access to clean water and sanitation and the strength of infection prevention and control measures”. He said in high-income countries the superbug problem was more about access to new drugs. The review was undertaken before the pandemic and there is concern that widespread use of antibiotics in the early days of the outbreak may have led to higher rates of AMR although the data is not clear yet.
Dr Jinks said: “There was a very significant change in antibiotic usage in the early days of the pandemic, but the data now are indicating that there is a more responsible use of antibiotics now that the treatment approaches for Covid is being becoming a bit more standardised and a bit more understood.” A study by the European Centres for Disease Control and Prevention found that antibiotic use actually feel in Europe during 2020, particularly for milder infections - probably because of increased social distancing.
However, he said that, as in other areas of healthcare, a lot of AMR work, for example, surveillance, was disrupted because of the pandemic. "Where there has been good anti-microbial stewardship in hospitals it's been very hard for them to maintain those systems in this crisis situation," he said. "We don't have the numbers yet but we're looking at proxy indicators such as antibiotic usage," he said.
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