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Monday, June 27, 2022

Explained: The global toll of bacterial resistance to drugs

🔴 The Global Research on Antimicrobial Resistance (GRAM) report used statistical modelling to estimate deaths linked to 23 pathogens and 88 pathogen-drug combinations.

Written by Anuradha Mascarenhas | Pune |
Updated: January 20, 2022 12:05:07 pm
Hospital staff at a Covid-19 isolation ward in Ahmedabad. (Express Photo: Nirmal Harindran)

Hundreds of thousands of deaths occur today due to previously treatable infections — such as lower respiratory and bloodstream infections — because the bacteria that cause them have become resistant to treatment. A comprehensive estimate of the global impact of antimicrobial resistance (AMR), covering 204 countries and territories and published in The Lancet, has found that 1.27 million people died in 2019 as a direct result of AMR, which is now a leading cause of death worldwide, higher than HIV/AIDS or malaria.

The analysis

The Global Research on Antimicrobial Resistance (GRAM) report used statistical modelling to estimate deaths linked to 23 pathogens and 88 pathogen-drug combinations. Apart from 12.7 lakh deaths caused directly by AMR (these would not have occurred had the infections been drug-susceptible), another 49.5 lakh deaths were associated with AMR (a drug-resistant infection was implicated, but resistance itself may or may not have been the direct cause of death). HIV/AIDS and malaria were estimated to have caused 8.6 lakh and 6.4 lakh deaths respectively in 2019.

Of the 23 pathogens studied, drug resistance in six (E coli, S aureus, K pneumoniae, S pneumoniae, A baumannii, and P aeruginosa) led directly to 9.29 lakh deaths and was associated with 3.57 million. One pathogen-drug combination – methicillin-resistant S aureus, or MRSA – directly caused more than 1 lakh deaths. Resistance to two classes of antibiotics often considered the first line of defence against severe infections – fluoroquinolones and beta-lactam antibiotics – accounted for more than 70% of deaths caused by AMR.

AMR-related deaths

Antibiotics in Covid

“There is a lot of improper use of antibiotics happening in Covid too. A study reported by ICMR (Indian Council of Medical Research) from 10 hospitals showed that when Covid patients acquire drug-resistant infections in hospitals, the mortality is almost 50-60%,” said Dr Kamini Walia, programme officer, AMR, ICMR. “However data is difficult to collect because of absence of hospital information systems in most hospitals. The real impact of drug-resistant infections in patients can be determined when the laboratory reports are connected with the clinical outcome,” Dr Walia said.

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Dr Ramanan Laxminarayan, Center for Disease Dynamics, Economics & Policy (US), who was not involved in the study, told The Indian Express that until changes in ICMR guidelines earlier this week, azithromycin was routinely prescribed for all Covid patients even though there is no evidence that this is helpful.  “… The absolute lack of regard for the life-saving value of antibiotics may come back to haunt us when we need these drugs for bacterial infections,” he said.

Why data matter

“This is the first time we have evidence-based numbers as to what could be the toll of drug resistance in terms of morbidity and mortality,” Dr Walia said. “We have tried to come up with what could be the burden of these infections in the country. However deaths are not recorded due to drug-resistant infections but reported mainly as symptoms or the disease with which the patient got admitted,” Dr Walia said. “… it (drug resistance) has yet to be linked with clinical outcomes. That has been one of the key reasons why we have not got the policymakers’ attention to do something substantial to address the problem.”

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