Antimicrobial resistance occurs when bacteria or other pathogens change in ways that they become resistant to antimicrobials

More than 39 million people around the world could die from antibiotic-resistant infections over the next 25 years, a study published in The Lancet has warned. 

The research, conducted by the Global Research on Antimicrobial Resistance (GRAM) Project,  marks the first global analysis of antimicrobial resistance (AMR) trends over time. 

AMR occurs when bacteria or other pathogens change in ways that they become resistant to antimicrobials.

More than one million people have died each year as a result of AMR between 1990 and 2021, it revealed. The study also estimates 1.91 million people could potentially die as a direct result of AMR in 2050, an increase of almost 70% per year compared to 2022. Over the same period, the number of deaths in which AMR bacteria play a role will increase by almost 75% from 4.71 million to 8.22 million per year.

Between 1990 and 2021, AMR deaths among children under five years old declined by 50%, while those among people aged 70 years and older increased by more than 80%. These trends are predicted to continue in the coming decades, with AMR deaths among children under five projected to halve by 2050 globally, as deaths among people 70 years and older more than double.

The findings highlight a vital need for interventions that incorporate infection prevention, vaccination, minimising inappropriate antibiotic use, and research into new antibiotics to reduce the number of AMR deaths.

“Antimicrobial medicines are one of the cornerstones of modern healthcare, and increasing resistance to them is a major cause for concern,” Dr Mohsen Naghavi, Team Leader of the AMR Research Team at the Institute of Health Metrics (IHME), University of Washington, said. “Understanding how trends in AMR deaths have changed over time, and how they are likely to shift in future, is vital to make informed decisions to help save lives.” 

Already widely recognised as a major global health challenge, AMR is anticipated to worsen in the coming decades. However, until now, no studies have assessed historical trends of AMR and provided in-depth forecasts of future global impacts.

The first GRAM study, published in 2022, revealed the true scale of AMR for the first time. It found that global AMR-related deaths in 2019 were higher than those from HIV/AIDS or malaria, leading directly to 1.2 million deaths and playing a role in a further 4.95 million deaths.

Estimates for the new GRAM study were produced for 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes (including meningitis, bloodstream infections, and other infections) among people of all ages in 204 countries and territories. The estimates were based on 520 million individual records from a wide range of sources, including hospital data, death records, and antibiotic use data, the Lancet said.

Statistical modelling was used to produce estimates of deaths directly from AMR and those in which AMR played a role. Based on the historical trends, the authors estimated the most likely global and regional health impacts of AMR from 2022 until 2050. Estimates were also produced for scenarios in which healthcare quality and access to antibiotics improve in the future and drug development targets Gram-negative bacteria.

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