Antibiotic resistance ‘killed more than HIV and malaria’

Scientists have attributed thousands of deaths in Kenya to antimicrobial resistance(AMR).

According to the first comprehensive global assessment of AMR, the deaths of 8,500 Kenyans in 2019 were attributed to AMR. The scientists also associated 37,300 deaths to AMR.  In the study released last month and published in The Lancet Global, the researchers note that there were an estimated 1.05 million deaths associated with bacterial AMR in Africa. During the same period, 250,000 Africans died of bacterial AMR.

This means that AMR was a bigger cause of death than HIV/Aids and malaria  in 2019 though the two diseases got far more funding and attention compared to AMR. The same year in Africa, 639,554 people died of HIV/Aids while 594.348 people succumbed to malaria.  

The assessment found that deaths due to infections across the African region ranged from 14 per cent in Algeria to 64 per cent in Chad.

 “Additionally, we estimated that 48 per cent of infection-related deaths were associated with AMR in Algeria (highest in the region), while Chad was estimated at 25 per cent. The lowest fractions of infection-related deaths associated with AMR were in Lesotho (17 per cent) and South Africa (17 per cent),” the researchers said.

The largest fatal AMR burden was attributed to lower respiratory and thorax infections (119, 000 deaths;48 per cent of all estimated bacterial pathogen AMR deaths, bloodstream infections (56 000 deaths; 22 per cent), intra-abdominal infections (26 000 deaths; 10 per cent), and tuberculosis (18 000 deaths; seven per cent).

“We estimated 3·83 million deaths in 2019 involving infection in the World Health Organization (WHO) African region. 1·86 million of those deaths were caused by both susceptible and resistant bacteria and of these, 1·05 million deaths were associated with AMR. Some 250,000 deaths   were attributable to AMR,” they explained,  noting that the WHO African region has the largest fatal and non-fatal burden of AMR compared with any other WHO region.  “Despite the relatively low prevalence of resistance in the region, the sheer number of infections yields high AMR mortality,”they concluded. The researchers also found that seven leading pathogens were collectively responsible for 821, 000 deaths associated with resistance on the continent, with four pathogens exceeding 100,000 deaths each — Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus.

Third-generation cephalosporin-resistant K pneumoniae and meticillin-resistant S aureus were shown to be the leading pathogen–drug combinations in 25 and 16 countries, respectively (53 per cent  and 34 per cent  of the whole region, comprising 47 countries) for deaths attributable to AMR,” the researchers observed, highlighting that  the rapid acceleration of AMR  is a major concern for the future of global health and modern health care.

The Lancet Global points out that the study is the most comprehensive analysis of the burden of bacterial AMR in the  WHO African Region to date, providing estimates for 47 countries, 23 bacterial pathogens, and 88 pathogen–drug combinations in 2019.

Researchers explained that in a scenario in which drug-resistant infections are replaced with drug-susceptible ones, they considered the excess risk of resistance known as the attributable to AMR counterfactual scenario. “Deaths attributable to AMR were calculated by multiplying the number of deaths for each underlying cause by the fraction of these deaths in which infection was implicated, followed by multiplying the fraction of infectious deaths attributable to each infectious syndrome. This was then multiplied by the fraction of infectious syndrome deaths attributable to each pathogen and by a mutually exclusive risk-weighted estimate of burden attributable to resistance that takes into account patterns of co-resistance among different antibiotics for each location-year and pathogen–drug combination.”

“The burden of AMR in sub-Saharan Africa has largely remained undefined, and this study presents an extensive set of estimates for bacterial AMR burden from priority pathogen–drug combinations in this region,” said the researchers.

The study found that while the threat of AMR is substantial across the globe, its burden is disproportionately high in low-income and middle-income countries (LMICs. The experts added that many LMICs, including those in sub-Saharan Africa, lack access to crucial, more effective antibiotics, which might contribute to increased AMR burden.  

They further explained that their overall approach can be divided into five broad components: the number of deaths involving infection, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of death or duration of an infection associated with this resistance.

“The study revealed that the countries with more education and income, and lower fertility, tended to have lower levels of death linked to antibiotic resistance,” the researchers said while comparing socio-demographic Index – a metric that combines income, fertility, and education – to antibiotic resistance deaths per 100,000 people and found a strong correlation.

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