Bacterial infections that don’t respond to antibiotic treatment are a serious public health threat and a leading cause of death globally. In 2019, an estimated 1.27 million people died from antibiotic-resistant infections, which is more than the number of deaths caused by HIV/AIDS or malaria that year, according to a new, comprehensive report published in Lancet.

Antibiotics typically work by slowing or stopping the growth of bacteria. Antibiotic resistance occurs when bacteria develop ways to survive, continuing to grow and cause infection despite being treated with an antibiotic drug. Misuse and overuse of antibiotics have contributed to this increasing worldwide problem.

An international group of researchers called the Antimicrobial Resistance Collaborators conducted an extensive analysis of data from hospitals, laboratories, surveillance systems, literature reviews and other sources in 204 countries and territories. They found that, overall, antibiotic resistance was a factor in an estimated 4.95 million deaths worldwide in 2019, including the 1.27 million deaths that were directly linked to antibiotic-resistant infections.

Infections resistant to treatment with two types of antibiotics called fluoroquinolones and beta-lactams, which include penicillin and cephalosporin, were implicated in more than 70% of the deaths. These drugs are considered crucial tools for treating serious bacterial infections.

Out of the 23 types of bacteria that were studied, six types were the cause of the vast majority of deaths–nearly one million–directly linked to antibiotic resistance. Of those six types of bacteria, the top three causing the most fatal infections were Escherichia coli (E. coli), Klebsiella pneumoniae and Staphylococcus aureus, commonly called staph. When the researchers looked at types of bacteria that were resistant to specific antibiotics, they found that methicillin-resistant S. aureus (MRSA) was the leading cause of deaths.

In 2019, the most common types of antibiotic-resistant infections directly causing deaths were chest and lower respiratory tract infections, including bacterial pneumonia, followed by bloodstream infections (septicemia) and infections within the abdomen. Collectively, these three accounted for nearly 79% of deaths attributed to antibiotic resistance.

Areas of the world with limited resources were most affected by deaths due to antibiotic-resistance. Sub-Saharan Africa and South Asia had the highest rates, with an estimated 24 and 22 deaths per 100,000 people, respectively. Developed nations with high incomes, which includes the U.S., also had notable rates of 13 deaths per 100,000.

Preventing infections by improving hygiene and sanitation practices as well as through vaccines are important strategies for combating antibiotic resistance, note the authors of the report. Appropriate use of antibiotics by only prescribing them to treat bacterial infections, and increasing access to antibiotics for resource-poor areas of the world are also key. The authors call for an increase in funding to develop new vaccines and new drugs to treat bacterial infections as well.

An editorial in the same journal echoed the call for investing in the development of effective antibiotic drugs and vaccines, and suggested redirecting resources from some other global projects. Additional ways to confront the issue were noted, including raising awareness among the public, enhancing testing and diagnosis, and improving the means of tracking antibiotic resistance around the world.

For more in-depth information, read the article Antibiotic Resistance in Bacteria.


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