Global deaths from antibiotic resistance (2019)

Overview

Antimicrobial Resistance Collaborators. Lancet 2022 · PMID 35065702 · DOI 10.1016/S0140-6736(21)02724-0

About 1.27 million deaths were directly caused by resistant bacteria in 2019.

Does the study support the specific claim? Yes · Methodological quality: high

Original publication

Plain-language summary

Scientific in-depth review

1. Full reference

Authors

Antimicrobial Resistance Collaborators

Journal

Lancet

Year

2022

Identifier

PMID 35065702 DOI 10.1016/S0140-6736(21)02724-0 · PMC8841637

Verification

verified – PubMed E-utilities efetch, 2026-10-25

Retracted

no

Corrections

PubMed lists: ErratumIn (Lancet. 2022 Oct 1;400(10358):1102. doi: 10.1016/S0140-6736(21)02653-2.)

Extent checked

full text

Conflicts of interest and funding

Declaration of interests E Ashley reports that Lao-Oxford-Mahosot Hospital—Wellcome Trust Research Unit received financial support from the Global Research on Antimicrobial Resistance Project (GRAM) to extract and prepare data for the present manuscript. J Bielicki reports grants from the European and Developing Countries Clinical Trials Partnership, Horizon 2020, and Swiss National Science Foundation, and a contract from the National Institute for Health Research (NIHR), outside of the submitted work; and consulting fees from Shionogi and Sandoz and speaking fees from Pfizer and Sandoz, outside the submitted work. C Carvalheiro reports financial support for the present manuscript from the Global Antibiotic Research and Development Partnership, who provided payments to Fundação de Apoio ao Ensino, Pesquisa e Assistência of the Clinical Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil. S Dunachie reports financial support for the present manuscript from UL Flemming Fund at the Department of Health and Social Care, the Bill & Melinda Gates Foundation, and the Wellcome Trust; a paid membership role for the Wellcome Trust Vaccines Advisory Selection Panel Vaccines and AMR in November, 2019; and an unpaid role as an expert adviser to WHO's Global Antimicrobrial Resistance Surveillance System, from November, 2018 onwards, outside the submitted work. A Haselbeck reports support for the present manuscript from the Bill & Melinda Gates Foundation (OPP1205877). C Lim was supported by the Wellcome Trust Training Fellowship between September, 2017 and March 2020 (206736/Z/17/Z), outside the submitted work. M Mussi-Pinhata reports support for the present manuscript from research from grant funding from Fondazione PENTA—Onlus and the Clinical Trial Manager Global Antibiotic R&D Partnership (GARDP). P Newton reports support for the present manuscript from research grant funding from the Wellcome Trust. J Robotham is a member of the UK Government Advisory Committee on Antimicrobial Prescribing Resistance and Healthcare Associated Infections, outside the submitted work. J Scott reports that the London School of Hygiene & Tropical Medicine (LSHTM) received financial support from Emory University to support CHAMPS projects in Ethiopia for the present manuscript; reports a paid fellowship from the Wellcome Trust, research grants from Gavi, the Vaccine Alliance, and NIHR paid to LSHTM, and an African research leader fellowship paid to LSHTM by the Medical Research Council, outside the submitted work; and reports being a member of the data safety and monitoring board for PATH Vaccines Solutions for SII PCV10 in The Gambia. J Sifuentes-Osornio reports financial support from Oxford University for the present manuscript; research grants from Oxford, CONACYT, Sanofi, and Novartis, outside of the study; consulting fees from Senosiain and speaker fees from Merck, outside of the study; and membership of the Sanofi advisory board of COVID-19 Vaccine Development, which is currently in progress, outside of the study. A J Stewardson reports grants or contracts from Merck, Sharp, & Dohme paid to Monash University, Melbourne, outside of the study. P Turner reports grants, consulting fees, and support for attending meetings or travel from Wellcome Trust, outside the study. H van Doorn reports grants or contracts from the University of Oxford and is the principal investigator for the Fleming Fund pilot grant; and he is a board member of Wellcome Trust's Surveillance and Epidemiology of Drug Resistant Infections. T Walsh reports financial support from the Bill & Melinda Gates Foundation for the BARNARDS (neonatal sepsis and mortality) study for the present manuscript. All other authors declare no competing interests.

2. Research question

Global burden of bacterial AMR in 2019

3. Study design and population

Study design

Risk assessment – Systematic analysis and predictive modelling (GBD) of AMR burden in 204 countries

Population

Global

Country

204 countries

Period

2019

Sample size

471 million records/isolates; 7585 study-location-years

Inclusion and exclusion criteria

23 pathogens, 88 pathogen-drug combinations

4. Methods and endpoints

Exposure / intervention

Resistant infections

Comparator

Counterfactuals: susceptible infection / no infection

Endpoints

Attributable and associated deaths, DALYs

Statistical methods

Bayesian/statistical modelling; 95% UIs

5. Actual results

Results

4.95 million (3.62-6.57) associated; 1.27 million (0.911-1.71) attributable deaths; highest western sub-Saharan Africa 27.3/100,000, lowest Australasia 6.5/100,000; MRSA >100,000 attributable deaths.

Absolute risks

Rates per 100,000 by region (see results).

Authors' conclusion

AMR is a leading cause of death, highest in low-resource settings; serious data gaps.

6. Strengths

• Most comprehensive estimate
• Full text partly read (PMC web page)

7. Weaknesses

• Model-based; sparse data in many countries

8. Risk of bias

Orienting tool

none applicable

Type of assessment

simplified assessment (abstract only)

Full formal assessment

no

Overall risk of bias

some concerns

Rationale

Modelling assumptions; industry COIs of some authors outside the work.

9. Assessment of the statistical interpretation

Wide uncertainty intervals.

10. Relevance to the specific claim

C-ABX-02, C-ABX-03, C-ABX-12.

11. Independent contrary findings

12. Transferability to Germany and Europe

High.

13. Overall methodological judgement

Authoritative; archive adds an unsupported comparison.

14. Open questions

15. Linked fact checks

• Bacterial antimicrobial resistance (AMR) was associated with 4.95 million deaths in 2019, of which 1.27 million were directly attributable to resistance. – Studies supporting the claim
• The AMR death toll exceeds HIV and malaria combined. – Studies contradicting or limiting the claim
• Antibiotics should not be used as a treatment at all; nobody should take an antibiotic for any reason (not even after a tooth extraction); the body can cope on its own. – Studies contradicting or limiting the claim

Use by the Tayebat archive

Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.

What the archive says about the study

4.95 million deaths were associated with bacterial AMR in 2019, with 1.27 million directly attributable - exceeding HIV and malaria combined.

A. What was actually studied?

AMR burden.

B. What did the authors find?

As reported.

C. What conclusions do the authors themselves draw?

AMR leading cause of death.

D. What does the archive derive from it?

Adds 'exceeding HIV and malaria combined'.

E. Is this derivation scientifically justified?

Numbers correct; the paper says AMR ranks 'ahead of both HIV and malaria' (separately), not 'combined'.

Adequacy of the interpretation (by the archive)

partly correct but over-interpreted