Antibiotic resistance more deadly than HIV and malaria – Resistant bacteria cause more than 1.2 million deaths worldwide every year –

Insidious disease: A study reveals that more people worldwide are now dying from resistant bacteria than from HIV or malaria. In 2019 alone, 1.27 million deaths were directly related to antibiotic resistance, with 4.9 million more closely associated. Diseases that used to be easily treatable with antibiotics, such as bacterial pneumonia, sepsis or the consequences of appendicitis, are now increasingly fatal, as the research team reports in the specialist journal The Lancet.

The discovery of penicillin heralded a new era in medicine. Once deadly infections became curable and antibiotics have since saved millions of lives. But in the meantime these weapons of medicine have become blunt. Increasingly, even emergency antibiotics are no longer effective because bacteria have developed resistance to them. They even undermine new active substances – sometimes even before they can be widely used.

Almost five million deaths closely linked to resistance

The balance of an international team led by Christopher Murray from the University of Washington in Seattle now underlines how dramatic the situation has become. For their report, they evaluated health data from hospitals, specialist literature, monitoring systems and other data sources on 471 million people from 204 countries. They examined deaths associated with 23 bacterial pathogens and 88 combinations of antibiotics and pathogens.

The result: In 2019 alone, more than 1.27 million people died worldwide as a direct result of an infection with resistant bacteria. They would still be alive if their pathogens hadn’t been immune to the antibiotics, as Murray and his colleagues point out. 4.95 million more deaths were closely linked to a resistant infection, in which the pathogens at least contributed to the deaths of the patients.

Country-specific proportions of carbapenem antibiotic-resistant isolates of Acinetobacter baumannii. © Murray et al./ The Lancet

Once treatable infections become deadly again

This means that antibiotic resistance is now one of the most common causes of death worldwide – more people die from resistant bacteria than from HIV or malaria. “These data reveal the true extent of antimicrobial resistance,” says Murray. “They are a clear signal that we urgently need to take action against this threat.” Children under the age of five are particularly hard hit by this insidious threat: They account for 20 percent of all deaths from resistant germs.

With the rise of resistant bacteria, diseases that were once treatable with antibiotics are once again deadly. According to the study, bacterial pneumonia is the most common cause of resistance-related deaths. They are followed by failed therapies for sepsis – popularly known as blood poisoning – and inflammation in the installation space that has gotten out of control, mostly as a result of appendicitis.

Six pathogens as “supergerms”

Of the 1.27 million deaths in 2019, 929,000 were due to six of the 23 pathogens examined. In descending order these were Escherichia coli, Staphylococcus aureus (MRSA), Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. Most of these pathogens are immune to two of the major classes of antibiotics – the fluoroquinolones and the beta-lactam antibiotics. Around 70 percent of deaths are due to such resistance alone, as the team determined.

MRSA proportions
Country-specific proportions of isolates of methicillin-resistant Staphylococcus aureus (MRSA). © Murray et al./ The Lancet

Sub-Saharan Africa and southern Asia are most affected by antimicrobial resistance. There, on average, 22 to 24 out of 100,000 deaths are directly attributable to resistant bacteria. There it is mainly infections with the pneumonia pathogens Klebsiella pneumoniae and Streptococcus pneumoniae that kill people. In rich countries and also in Europe, around 13 out of 100,000 deaths are directly attributable to resistant germs. Around half of these were caused by MRSA.

One of the reasons for the resistance that is rampant, especially in poorer countries, is that the people there often cannot afford the drugs and therefore do not complete the treatment. This allows resistant pathogens to survive and spread.

Action urgently needed

“We have to do something,” warns Ramanan Laxminarayan of the US Center for Disease Dynamics, Economics & Policy in an accompanying comment. “Until now, the threat has been hidden and unrecognized, but now a clearer picture of the burden of antibiotic resistance is emerging.” There is now an urgent need to spend more money on preventing infections and also making sure antibiotics are used correctly.

“Political and medical decision-makers at local, national and international level must take the fight against antibiotic resistance seriously,” says Laxminarayan. “So is the challenge of ensuring poorer populations have access to affordable and effective antibiotics.” (The Lancet, 2022; doi: 10.1016 / S0140-6736 (21) 02724-0)

What: The Lancet

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