Weighted regression models estimated how antimicrobial resistance (AMR) relates to population-level antibiotic consumption across 7 drug classes. Data covered over 30 million isolates of 16 pathogens from 114 countries, 2000 to 2018, with country-level controls. Associations were strongest for Acinetobacter spp., Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. A modelled 10% cut in antibiotic use was associated with 38,000 (95% CI 36,000–41,000) fewer annual AMR-attributable deaths. This was 0.50% of bacterial disease mortality globally, and 0.34% in sub-Saharan Africa. The main limitation is reliance on ecological relationships, with low-resource settings under-represented in the surveillance data.
Why it is interesting: It puts a figure on the AMR mortality linked to modifiable antibiotic use. The modelled gain is small against total bacterial disease deaths, including in sub-Saharan Africa, where bacterial disease mortality is highest.
Abstract — the authors' own words, CC BY
Background
Human antibiotic use is widely believed to contribute to the evolution and maintenance of antimicrobial resistance (AMR) in bacterial pathogens. While antibiotic stewardship should thus discourage use in situations where AMR-related harms outweigh clinical benefit, evidence to inform this assessment of tradeoffs is lacking, most notably in low-resource settings where gaps in antibiotic access persist. Quantitative understanding of use-resistance relationships is thus necessary as countries navigate commitments from the 2024 UN General Assembly resolution to reduce AMR burden by 2030. Methods and findings
We used global surveillance data on AMR prevalence from 2000 to 2018 representing over 30 million bacterial isolates from 114 countries, along with antibiotic consumption estimates for each country and year, to estimate elasticity relationships between AMR and antibiotic exposure. Our analyses addressed 16 bacterial pathogens and antibiotic consumption across 7 drug classes, controlling for country-level health and development indicators via weighted regression models. Across pathogens, evidence that AMR is associated with population-level antibiotic exposure is strongest for Acinetobacter spp., Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. In a modeled counterfactual scenario, we estimate that 10% lower levels of antibiotic use, in comparison to current levels, across classes, would be associated with 38,000 (95% confidence interval: 36,000-41,000) fewer annual deaths attributable to AMR globally. Although substantial, this total represents only 0.50% of estimated bacterial disease mortality. In sub-Saharan Africa, where risk of death due to bacterial disease is greatest, the modeled avertible burden of AMR-attributable deaths comprises only 0.34% of bacterial disease mortality. Key limitations of the study include reliance on ecological relationships to infer modifiable burden, and under-representation of low-resource settings in surveillance data on antibiotic consumption and AMR. Conclusions
Our findings suggest near-term achievable reductions in AMR-attributable deaths may be modest relative to the persisting burden of bacterial disease mortality. These estimates should inform assessments of the potential benefits and harms of restrictive versus permissive antibiotic use paradigms in epidemiologically distinct settings.
Cite this item
BibTeX
Free sign-up. A digest of the new papers twice a week, grouped by domain.
Other drivers in Behavioural science
-
Diet, exercise and sleep
What people eat and how much they move: what the measured evidence says each does to mortality, and what has been shown to change either.
1 this week -
Smoking and vaping
How far smoking has fallen and how many deaths it still causes, what vaping is doing to the people who take it up, and what generational bans will show.
4 this week -
Alcohol and drug use
What is happening to deaths from alcohol, drugs and suicide, whether they move together, and how much of it is behaviour and how much circumstance.
6 this week -
Social connection
Isolation, loneliness and mortality: what the evidence shows, how far the relationship is causal, and what interventions have shown.
1 this week -
Infection and pandemics
Infection and pandemics: the risks, and how well prepared we are
11 this week -
Adherence and persistence
Whether a treatment is actually taken, for how long, and what changes either.
4 this week
