Study estimates 1.27m deaths due to antimicrobial resistance in 2019

‘It will change modern medicine unless we do something about it.’
 
Such is the stark warning given by Professor Paul Glasziou, GP and the director of Bond University’s Institute for Evidence-Based Healthcare, about the rise of antimicrobial resistance (AMR).
 
Responding to new article published in The Lancet, which estimates there were more deaths globally due to AMR in 2019 than for both malaria and HIV combined, Professor Glasziou said the work highlights the scale of a growing healthcare issue.
 
The authors of the study calculated around 1.27 million people died directly from AMR that year, and state that their work includes ‘the most comprehensive estimates of AMR burden to date’.
 
Professor Glasziou believes that tracks with previous studies which suggest that AMR is posing a growing threat to healthcare worldwide.
 
The Review on Antimicrobial Resistance, commissioned by the UK Government in 2014 and published in 2016, projected 10 million people dying from AMR each year by 2050.
 
‘I think this is in line with that sort of projection,’ Professor Glasziou told newsGP. ‘If we stayed on track without doing anything about antibiotic resistance, then we’ll end up there.’
 
The report suggests Australia is currently positioned relatively well in terms of the raw number of deaths from AMR compared to other countries.
 
The study, which was partly funded by the Bill and Melinda Gates Foundation, Wellcome Trust, and the UK’s Department of Health and Social Care, used predictive statistical modelling to estimate the AMR burden globally, including for locations where no data was available.
 
It found the estimated death rate due to AMR is highest in western sub-Saharan Africa at 27.3 deaths per 100,000 and lowest in Australasia at 6.5 deaths per 100,000.

Professor Glasziou described that finding as ‘relatively surprising’.
 
‘We [in Australia] don’t do particularly well in primary care, in terms of antibiotic use, but we’re not the worst in the world, certainly,’ he said.
 
‘There are big problems in places like South Asia and Southeast Asia and some African places where people can get antibiotics over the counter without a doctor’s prescription, and they often get multiple different antibiotics. That’s a really serious concern for resistance.
 
‘The global trend is that the resistance is getting worse. And even if Australia is doing well, it’s still part of that trend.’
 
The most common cause of death where bacteria have become resistant to treatment is for lower respiratory infections including pneumonia, followed by bloodstream infections, the study found.
 
It also indicated that infections resistant to two classes of antibiotics, fluoroquinolones and beta-lactam antibiotics, accounted for more than an estimated 70% of deaths caused by AMR.
 
One of the study authors, Professor Christiane Dolecek of Oxford University’s Centre for Tropical Medicine and Global Health, said work to improve global tracking of AMR is a key concern.
 
‘With resistance varying so substantially by country and region, improving the collection of data worldwide is essential to help us better track levels of resistance and equip clinicians and policymakers with the information they need to address the most pressing challenges posed by antimicrobial resistance,’ she said.
 
The fourth report on Antimicrobial use and Resistance in Human Health (AURA) published by the Australian Commission on Safety and Quality in Healthcare last year highlighted the ongoing issue of over-prescribing.
 
‘While there has been a continuing gradual decline in community [antimicrobial use] up to 2019, more than 10 million people in Australia (40.3%) had at least one antimicrobial dispensed under the Pharmaceutical Benefits Scheme (PBS) or the Repatriation Pharmaceutical Benefits Scheme (RPBS) in 2019,’ the report reads.
 
‘This is much higher than most European countries and Canada. This is in addition to people who received antimicrobials during a stay in hospital.’
 
The researchers also said many antimicrobials were prescribed for conditions where there was no evidence of benefit, such as for acute bronchitis and acute sinusitis.
 
Professor Glasziou underlined the impact of AMR beyond the death toll, warning of the potential of an insidious, gradual ebbing of the power of antibiotics to help.
 
‘The other thing to recognise is that [AMR] undermines a lot of modern healthcare. Surgery, for example, and chemotherapy for cancer really rely on the fact that you’ve got antibiotics that will be effective,’ he said.
 
‘It’ll be a slow set of dominoes that starts to go down and it will change modern medicine unless we do something about it.’
 
While greater regulation could be a factor, education and training are key, he believes.
 
‘There’s been some improvements in regulation like the repeats on antibiotics,’ he said. ‘But it’s not the regulation so much as a coordinated and funded coordination of an antimicrobial stewardship program across general practice, which includes education and resources for training.
 
‘That’s really important.
 
‘It’s an interplay between community pressure, and GP knowledge and their ability to educate the population as well. We need those to work together.’
 
A forthcoming series in the Australian Journal of General Practice will help outline what further work could be done in Australia, he says.
 
Developing new medicines will also be important, Professor Glasziou believes – although he says the same issue is likely to evolve for any as yet undiscovered antibiotics.
 
‘Even if we got new antibiotics, most of the new antibiotics we’ve had over the last several decades start to develop resistance pretty quickly if we have this high use of them,’ he said.
 
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