Antibiotic-resistant infections killing more than HIV or malaria, major study shows

1.27 million people died from antimicrobial resistance in 2019, with children aged under five particularly vulnerable

Young children were found to be particularly at risk to AMR (Getty Images)

At least 1.27 million people died from antibiotic-resistant infections in 2019, a major new study has shown.

The analysis of 204 countries found that antimicrobial resistance (AMR) is now killing more people every year than HIV (860,000) or malaria (640,000).

“These new data reveal the true scale of antimicrobial resistance worldwide, and are a clear signal that we must act now to combat the threat,” said study co-author Professor Christopher Murray, of the Institute for Health Metrics and Evaluation at the University of Washington.

Published in The Lancet, the analysis shows that many hundreds of thousands of deaths now occur due to common, previously treatable infections – such as pneumonia – because the bacteria that cause them have become resistant to treatment.

The new Global Research on Antimicrobial Resistance (GRAM) study estimated the burden of disease in two ways: deaths that would not have happened had infections been susceptible to drug treatment, and deaths associated with AMR.

In 2019, AMR was directly responsible for an estimated 1.27 million deaths worldwide and associated with a further 4.95 million, according to the analysis.

Young children were found to be particularly at risk to AMR, with around one in five deaths in 2019 attributable to AMR occurring in children aged under 5.

Some 400,000 deaths were the result of drug-resistance to lower respiratory infections, such as pneumonia, while more than 1.5 million were associated with AMR.

Drug resistance in bloodstream infections – which can lead to the life-threatening condition sepsis – caused around 370,000 deaths and was associated with nearly 1.5 million.

“Previous estimates had predicted 10 million annual deaths from antimicrobial resistance by 2050, but we now know for certain that we are already far closer to that figure than we thought,” said Professor Murray.

“We need to leverage this data to course-correct action and drive innovation if we want to stay ahead in the race against antimicrobial resistance.”

Deaths caused directly by AMR were estimated to be highest in Sub-Saharan Africa (24 deaths per 100,000 population) and south Asia (22 per 100,000). In high-income countries, AMR led directly to 13 deaths per 100,000.

Drug resistance in just six pathogens, including E.coli and S.pneumoniae, led directly to 929,000 deaths and was associated with 3.57 million. One pathogen-drug combination – methicillin-resistant S. aureus, or MRSA – directly caused more than 100,000 deaths in 2019.

Dr Ramanan Laxminarayan, from the US centre for Disease Dynamics, Economics & Policy (CDDEP), who was not involved in the study, said: “A clearer picture of the burden of AMR is finally emerging.”

He said global spending on fighting AMR is lower than what is spent on HIV, even though antibiotic-resistant infections are now killing more people.

“This needs to change. Spending needs to be directed to preventing infections in the first place, making sure existing antibiotics are used appropriately and judiciously, and to bringing new antibiotics to market.”

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.

The authors acknowledged that the study will have been limited by a lack of data in some parts for the world, including many lower and middle-income countries, meaning strong methodological assumptions were made in the analysis.