There may be more than 39 million deaths by 2050 because of increased resistance to antibiotics in bacteria, global analysis found.
The study, published in The Lancet, found more than one million people died each year between 1990 and 2021 as a direct result of antimicrobial resistance (AMR), which occurs when bacteria or other pathogens evolve and no longer respond to antibiotics, so-called superbugs.
The number is expected to rise sharply, increasing by more than two thirds, or almost 70 per cent, to 1.91 million deaths in 2050, compared to 2022. But the number of deaths in which AMR bacteria play a role will also rise substantially, by almost 75 per cent from 4.71 million to 8.22 million a year, over the same period, the study found.
“Infections that are the most challenging for doctors to treat are becoming increasingly commonplace,” Mohsen Naghavi, professor of health metric science at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, told The National.
“Of the eight types of resistant bacteria that the World Health Organisation has identified as having low or medium-low treatability, all but one – Salmonella typhi – had increasing mortality between 1990 and 2021.”
Low and middle-income countries face the biggest burden of deaths from AMR, with sub-Saharan Africa and South Asia having the highest rates, and a particularly high number of deaths from multi-drug resistant tuberculosis, he said.
Deaths directly from AMR between 1990 and 2021 increased the most in five regions, where annual deaths rose by more than 10,000: western sub-Saharan Africa, Tropical Latin America, high-income North America, South-East Asia and South Asia.
Deaths because of AMR in children under the age of five halved between 1990 and 2021 but increased by more than 80 per cent in people aged 70 and older. The study found the trends are expected to continue, with deaths among under-fives projected to halve by 2050 globally, while doubling in people 70 and older.
“The fall in deaths from sepsis and AMR among young children over the past three decades is an incredible achievement. However, these findings show that while infections have become less common in young children, they have become harder to treat when they occur. Further, the threat to older people from AMR will only increase as populations age,” said study author Dr Kevin Ikuta of the University of California Los Angeles (UCLA) and affiliate professor at the IHME. “Now is the time to act to protect people around the world from the threat posed by AMR.”
Experts said the findings highlight an urgent need for action that prevents infections, encourages vaccination, minimises inappropriate antibiotic use and improves research into new antibiotics to reduce the number of AMR deaths forecast for 2050.
“Antimicrobial medicines are one of the cornerstones of modern health care and increasing resistance to them is a major cause for concern,” said study author Dr Mohsen Naghavi of the University of Washington. “These findings highlight that AMR has been a significant global health threat for decades and that this threat is growing. 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.”
A first study into the global impact of the problem, which was published in 2022, revealed that 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.
The study used modelling to look at 22 pathogens, 84 pathogen-drug combinations and 11 infections, including meningitis and bloodstream infections, among people of all ages in 204 countries and territories to build a picture of what might happen in the future.
The study found improving overall infection care and access to antibiotics could prevent 92 million deaths between 2025 and 2050, with the greatest benefits in South Asia, sub-Saharan Africa and parts of South-East Asia, East Asia and Oceania, with 31.7 million, 25.2 million and 18.7 million deaths averted, respectively.
If new antibiotics targeting Gram-negative bacteria were developed, estimates indicate 11.08 million AMR-attributable deaths could be averted globally over the same period, the authors said.
Prof Samuel Kariuki, of the Kenya Medical Research Institute, who was not involved in the study, said: “The model successfully evaluated the changing trends in AMR mortality across time and location that is necessary to understand how the burden of AMR is developing, and to provide evidence for action by all stakeholders to make informed decisions regarding interventions.
“These data should drive investments and targeted action towards addressing the growing challenge of AMR in all regions.”
