2021-01-28
The World Health Organization (WHO) classify antimicrobial resistance as one of the ten most considerable global public health threats humanity is facing. Medical and scientific communities have been aware for a long time. Still, the global burden of antibiotic resistance remains unknown.
What is burden?
Burden is a broad concept that could mean different things. It is commonly defined as mortality caused by a disease or condition of interest, but could also be measured in for example excess morbidity or additional economic costs (for individuals, health-care providers or society at large).
There are also different ways to measure and calculate mortality, which further complicates estimations and data comparisons. When considering burden of antibiotic resistance as the number of lost lives, do we mean the number of people that die while suffering from any antibiotic resistant infection (irrespective of presence of other diseases or conditions), the excess number of deaths caused by specific resistant infections or something else? And what do we compare to?
Important factors that influence the generation of mortality data is the diagnostic capacity of health systems and the procedures for determining and recording deaths due to antibiotic resistance. These are some important aspects that need to be addressed to improve the estimates of global burden.
Mortality burden data from low- and middle-income countries are particularly scarce, although it is well-recognized that these countries generally are more afflicted by antibiotic resistance. Health systems strengthening and efforts to ensure universal health coverage are therefore crucial also for data generation purposes.
Attributable mortality of antibiotic resistance
The excess number of deaths among patients with antibiotic resistant infections, compared to patients without resistant infections.
The World Health Organization (WHO) classify antimicrobial resistance as one of the ten most considerable global public health threats humanity is facing.
Some initiatives generating burden estimates
In June 2020, the WHO published a master protocol for estimating attributable mortality of antimicrobial resistant bloodstream infections, as part of the Global Antimicrobial Resistance Surveillance System (GLASS) framework. The protocol focuses, at first hand, on attributable in-hospital mortality of bloodstream infections caused by extended-spectrum beta-lactamase-producing (ESBL) E. coli and methicillin-resistant S. aureus (MRSA). Both these are relatively common pathogens that are resistant to clinically important antibiotics.
Although the initiative is very welcome, it is important to be aware of the limitations. The data will only be as good as the circumstances allow and will be influenced by everything from health-care seeking behavior to availability of clinical diagnostics, laboratories and trained personnel. The prerequisites for generating useful, representative data therefore varies substantially between countries.
The Global Burden of Disease (GBD) study make burden estimates for a lot of different conditions and diseases in 195 countries. In 2018, it was announced that GBD also will include human mortality and morbidity data on resistant infections. The work is carried out in partnership with the Global Research on AntiMicrobial resistance (GRAM) project, with the initial aim to generate antibiotic resistance burden estimates from year 1990 and onwards for 17 pathogen-antibiotic combinations. The first results are expected in 2021. However, making these estimations is far from straight-forward. Factors complicating burden estimations of antibiotic resistance are described in this article, and include:
- the unique characteristics of antibiotic resistance (for example that it is not a disease in itself and that bacteria may develop resistance to multiple antibiotics)
- the lack of microbiological data linked to patient data
- the choice of methodology
The importance of reliable global burden estimates
Why then is it important to have reliable burden estimates of antibiotic resistance? Isn’t it enough to simply know that antibiotic resistance is a profound problem? Probably not. There is a difference between knowing that something is an issue and being informed about the extent of the problem.
One could make an analogy to for example traffic. When driving a car on a road where many car accidents happen, the driver is hopefully paying more attention. However, if the driver knows that on average one traffic accident with deadly outcome happens every week at that specific road, the response is likely different. Maybe she or he cancels the trip or chooses an alternative, statistically safer, route. Besides, it is probably likelier that authorities and decision makers prioritize finding solutions to reduce the problem and make the road safer.
The same applies to antibiotic resistance. Knowing the extent of the problem in countries as well as globally would help communicating the urgency of the crisis. It could help inform policies, target interventions and increase general awareness, which all are important components of the antibiotic resistance response. With other words – lack of antibiotic resistance burden data may slow down national and global efforts, which is why it is so important to address. We must look more into how we can overcome the data gap. This includes continuing to strengthen health systems capability and capacity to detect and record the outcome of resistant infections, but also to complement data collection with for example point prevalence studies.
While continuing our efforts to overcome the data gap, we must recognize that we have enough knowledge and insight to take action here and now. We have no time to lose.
Learn more in the ReAct Toolbox
Data on the burden of antibiotic resistance is important for understanding the magnitude of the problem and for communicating the urgency to address the topic. Data on the burden attributable to resistance is still lacking from many parts of the world.
Learn more > Measure – Burden of antibiotic resistance
Further reading
WHO factsheet on antimicrobial resistance
GLASS method for estimating attributable mortality of antimicrobial resistant bloodstream infections
Measuring and mapping the global burden of antimicrobial resistance
The challenges of estimating the human global burden of disease of antimicrobial resistant bacteria
More news and opinion
- Winners ReAct Asia Pacific and Aspic Clubs photo competition 2021
- ReAct Africa Conference: Key takeaways and way forward
- World Health Assembly Special Session 2: Openings for stronger governance of the silent antibiotic resistance pandemic
- Staff interview Juan-Carlos Lopez
- ReAct highlights during World Antibiotic Awareness week 2021
- Staff interview Maria Pränting
- 5 lessons learned from Latin American Summit: Community empowerment – vital for tackling AMR
- The WHA74 Special Session on Pandemic Preparedness and Response – an opportunity to address antibiotic resistance
- ReAct announces the top 15 teams to participate in the online global design sprint Innovate4Health 2021
- City of Hyderabad joins ‘Go Blue’ campaign as part of WAAW Activities
- ReAct Europe and Uppsala University go blue to shed light on the antibiotic resistance issue
- Could the best chemotherapy be an antimicrobial drug?
- Press release: Unique collaboration between Ministry of Health, Zambia and ReAct Africa
- Mobilizing communities to act on antibiotic resistance
- ReAct activities for World Antimicrobial Awareness Week 2021
- Dr Vijay Yeldandi
- 4-day Summit: Latin America discusses the role of the community in National Action Plans on AMR
- The world needs new antibiotics – so why aren’t they developed?
- 3 ways the new WHO costing & budgeting tool supports AMR National Action Plan work
- 5 years after the UN Political Declaration on AMR – where are we now?
- Víctor Orellana
- Local production of vaccines and medicines in focus: Key points from ReAct and South Center UN HLPF side-event
- Behavior change to manage antimicrobial resistance: 8 briefs and 1 webinar-launch by Uppsala Health Summit
- ReAct and ICARS to develop policy guides and tools for low resource settings
- Tapiwa Kujinga, Director of PATAM: In Zimbabwe civil society is involved in every aspect of the response to AMR
- COVID-19: India pays a high price for indiscriminate drug use
- Lancet Global Health article release: Resetting the agenda for antibiotic resistance
- 3 key takeaways for AMR from this year’s World Health Assembly WHA74
- Antibiotic resistance – far more than a medical problem
- UN High-level Dialogue on AMR: political will and investments needed
- Resetting the agenda for antibiotic resistance through a health systems perspective
- 3 questions to newly appointed STAG-AMR members Otridah Kapona and Sujith Chandy
- Walk the talk: time is ticking for all to act on antibiotic resistance!
- Vanessa Carter: 3 years of surviving a drug-resistant infection made me want to create change
- Upcoming ReAct Webinar: Expert Conversation about new report
- ReAct report: Governments need to take more leadership to ensure global sustainable access to effective antibiotics
- 4 considerations for addressing antimicrobial resistance through pandemic preparedness
- Preventing the next pandemic: Addressing antibiotic resistance
- 4 key takeaways from the virtual ReAct Africa Conference 2020
- The threat of the unknown: is lack of global burden data slowing down work on antibiotic resistance?
- ReAct input to the WHO Executive Board Session on Antimicrobial Resistance
- Dr Gautham: informal health providers key to reducing antibiotic use in rural India