Over 39 million people could die from antibiotic-resistant infections by 2050, according to a recent study. The research reveals a troubling rise in deaths related to antimicrobial resistance (AMR) and provides forecasts for its impact over the next few decades.
Global analysis of antimicrobial resistance
Conducted by the Global Research on Antimicrobial Resistance (GRAM) Project , the study is the first comprehensive global analysis of antimicrobial resistance trends over time.
The research shows that from 1990 to 2021, more than one million people died each year due to antimicrobial resistance.
By 2050, the number of annual deaths directly caused by AMR could rise to 1.91 million, representing a nearly 70% increase compared to 2022.
Furthermore, the overall role of antimicrobial resistance in contributing to deaths is expected to grow significantly, with the number of deaths where AMR plays a role projected to increase from 4.71 million to 8.22 million per year.
Trends in antimicrobial resistance deaths
The study highlights that while AMR-related deaths among children under five have halved during this period, there has been a disturbing rise in deaths among those aged 70 and older, increasing by more than 80 percent.
This trend is predicted to continue, with the elderly population bearing the brunt of the future AMR burden. By 2050, AMR deaths among people aged 70 and older are expected to more than double, while deaths in children under five will continue to decline globally.
Urgent interventions are needed
The authors emphasize the need for urgent interventions to prevent this forecasted surge in AMR-related deaths. These interventions include stronger infection prevention measures, increased vaccination efforts, reducing inappropriate antibiotic use, and accelerating research into new antibiotics.
Mohsen Naghavi leads the AMR Research Team in the Institute of Health Metrics (IHME), University of Washington.
“Antimicrobial medicines are one of the cornerstones of modern healthcare, and increasing resistance to them is a major cause for concern. These findings highlight that AMR has been a significant global health threat for decades and that this threat is growing,” said Naghavi.
“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.”
Tracking antimicrobial resistance over time
The study also reveals that while antimicrobial resistance has long been recognized as a global health challenge, this is the first in-depth analysis to track the historical trends of AMR over time and provide future projections.
The first GRAM study, published in 2022, highlighted the global scale of the issue, revealing that AMR-related deaths in 2019 were higher than those from HIV/AIDS or malaria .
The new GRAM study analyzed data from 204 countries and territories, covering 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes.
The estimates were based on 520 million individual records sourced from hospital data, death records, and antibiotic use data.
Direct and indirect deaths
Using statistical modeling, the researchers produced estimates of deaths directly caused by AMR and those where AMR played a role. These trends provided projections for AMR's global and regional health impacts from 2022 until 2050.
The analysis reveals that deaths directly caused by AMR rose slightly from 1.06 million in 1990 to 1.14 million in 2021.
During this time, there was a significant age-related shift: deaths among children under five dropped by more than 50%, while deaths in people aged 70 and older increased by 80%.
This rise in older adults' deaths is largely attributed to aging populations and their increased vulnerability to infections.
Certain regions have experienced the highest increases in AMR deaths over the past three decades. These include western sub-Saharan Africa, Tropical Latin America, high-income North America, Southeast Asia, and South Asia.
Increasing threat to older populations
Despite advances in reducing AMR deaths in children, infections have become harder to treat when they occur, particularly in older populations. This underscores the importance of further action.
Study co-author Kevin Ikuta is an assistant professor of infectious diseases at the University of California, Los Angeles .
“The fall in deaths from sepsis and AMR among young children over the past three decades is an incredible achievement,” said Professor Ikuta.
“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.”
Alarming trends uncovered
The study also reveals alarming trends regarding bacterial pathogens and resistance.
Deaths due to methicillin-resistant Staphylococcus aureus (MRSA) more than doubled globally from 57,200 in 1990 to 130,000 in 2021.
Among Gram-negative bacteria , carbapenem resistance increased from 127,000 deaths in 1990 to 216,000 in 2021. These increases highlight the need for new antibiotics to combat the most resistant strains.
Future projections indicate that, without significant intervention, AMR deaths will continue to rise steadily, with an estimated 1.91 million annual deaths directly caused by AMR by 2050.
The broader role of AMR in contributing to deaths is expected to affect over 8 million deaths annually by mid-century. Cumulatively, AMR is forecasted to lead to more than 39 million direct deaths and be associated with 169 million deaths between 2025 and 2050.
Antimicrobial resistance deaths could be avoided
The study also suggests that action could avert many of these deaths. Improved infection care and increased access to antibiotics could prevent 92 million deaths between 2025 and 2050.
This would be especially impactful in regions like South Asia, sub-Saharan Africa, and parts of Southeast Asia, where millions of lives could be saved.
Developing new antibiotics targeting Gram-negative bacteria could prevent over 11 million AMR-attributable deaths.
New strategies are urgently needed
Dr. Stein Emil Vollset, study author from the Norwegian Institute of Public Health, stressed the urgency of addressing antimicrobial resistance.
“There has been real progress in tackling AMR, particularly among young children, but our findings indicate more must be done to protect people from this growing global health threat,” said Dr. Vollset.
“By 2050, resistant infections could be involved in some 8 million deaths each year. To prevent this from becoming a deadly reality, we urgently need new strategies.”
Growing challenge of antimicrobial resistance
Despite the progress, the authors note several limitations in their study. A lack of data from low- and middle-income countries (LMICs) calls for better data collection and infrastructure to improve the accuracy of future AMR forecasts.
Additionally, some of the individual records used in the study may contain biases or errors, and limited reporting of AMR data before 2000 may have affected the accuracy of historical estimates.
In a related comment, Professor Samuel Kariuki of the Kenya Medical Research Institute , who was not involved in the study, praised the model for effectively assessing the changing trends in AMR mortality.
“These data should drive investments and targeted action towards addressing the growing challenge of AMR in all regions,” concluded Professor Kariuki.
The study is published in the journal The Lancet .
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