Upcoming estimations suggest that around 40 million individuals might perish due to antibiotic-resistant bacterial infections by the year 2050.
Over the period of 2025 to 2050, the world could encounter over 39 million fatalities directly linked to antibacterial resistance or ABR, as reported in a study published on Monday in the journal The Lancet.
Antibacterial resistance occurs when microorganisms like bacteria and fungi develop a resistance to the medications intended to eliminate them.
The World Health Organization (WHO) has labeled ABR as "one of the major global health and development threats," mainly due to the misuse and excessive use of antibacterial medications in humans, animals, and plants, which can induce microorganisms to develop resistance towards them.
The new study reveals that the prevalence and consequences of ABR are projected to worsen, stated lead author Dr. Chris Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington.
"It's essential to have increased focus on the development of new antibiotics and antibiotic stewardship to tackle this significant issue," Murray said.
Elderly individuals bear the brunt
Researchers from the Global Research on Antimicrobial Resistance Project, the Institute for Health Metrics and Evaluation, and other institutions analyzed deaths and illnesses linked to versus associated with antibacterial resistance for 22 microorganisms, 84 microorganism-drug combinations, and 11 infections across 204 countries and territories from 1990 to 2021. A death directly linked to antibacterial resistance is caused by it, whereas a death associated with antibacterial resistance may have an underlying causation that is exacerbated by the antibacterial resistance.
Approximately 520 million data entries were utilized to generate these estimates.
The researchers discovered that from 1990 to 2021, deaths related to ABR decreased more than 50% among children under five but increased more than 80% among adults aged 70 and older – trends that are predicted to persist.
"It was surprising to observe these patterns emerge," Murray noted.
"We observed a decline in ABR deaths below the age of 15, predominantly due to vaccinations, water and sanitation programs, some treatment programs, and the success of such initiatives," Murray said.
"Simultaneously, we noticed a steady increase in the number of deaths among individuals aged 50 and older," he added, as the global population ages; elderly individuals may be more susceptible to severe infection.
The researchers found that the microorganism-drug combination responsible for causing the most burden across all age groups was methicillin-resistant Staphylococcus aureus, or MRSA. For this combination – the antibiotic methicillin and the bacteria S. aureus – the number of attributable deaths nearly doubled from 57,200 in 1990 to 130,000 in 2021.
Using statistical modeling, the researchers also generated estimates of deaths and illnesses attributed to ABR by 2050 in three scenarios: if the current situation persists, if new potent antibacterial drugs are developed to target resistant microorganisms, and if the world has improved the quality of healthcare for infections and better access to antibacterial drugs.
The forecasts suggest that deaths from ABR will increase by 2050 if measures are not put in place to improve access to quality care, powerful antibacterial drugs, and other resources to reduce and treat infections.
The researchers estimated that, in 2050, the number of global deaths attributable to ABR could reach 1.9 million, and those associated with ABR could reach 8.2 million.
According to the data, the regions of the world most affected by ABR and attributable deaths are South Asia, Latin America and the Caribbean, and sub-Saharan Africa – and many of these regions lack equitable access to quality care, Murray said.
"There are still numerous places in low-resource settings where people requiring antibacterial drugs are simply not receiving them, and that's a significant part of it," Murray said.
"It's not just the antibacterial drugs. It's when you're ill, either as a child or an adult, and you end up in the hospital, and you receive a package of care, effectively, that includes things like oxygen," Murray added.
"In low-resource settings, even essentials like oxygen are often unavailable. And if you are severely ill and require an intensive care unit, well, there are numerous low-resource regions – almost all of them, actually – where you wouldn't have access to such care," he stated. "So, there's a continuum of supportive care, in combination with the antibacterial drugs, that truly makes a difference."
However, in a scenario where the world has superior healthcare, approximately 92 million cumulative deaths could be avoided between 2025 and 2050, the researchers forecast. And in a scenario where the world has new, more potent drugs, approximately 11 million cumulative deaths could be prevented.
"Possible hope on the horizon"
The "innovative and collaborative" approach to this study provides a "comprehensive examination" of antibacterial resistance and its potential impact on the world, wrote Samuel Kariuki of the Kenya Medical Research Institute in a commentary that accompanied the new study in The Lancet.
Nevertheless, he cautioned that the forecast models do not account for the emergence of new superbugs "and might lead to underestimation if new microorganisms arise."
Generally, "these data should motivate investments and targeted action" toward addressing the growing issue of antibacterial resistance in all regions of the world, Kariuki concluded.
The new paper represents decades of research on the global burden of antibacterial resistance, said Dr. Steffanie Strathdee, associate dean of global health sciences and distinguished professor at the University of California San Diego School of Medicine, who was not involved in the study.
Strathdee witnessed firsthand the impact that antibacterial resistance can have on health when her husband nearly died from a superbug infection.
I've spent the past eight years dealing with antimicrobial resistance affecting my family. My spouse, let's call him Ted, nearly faced death due to a superbug infection. This specific infection is also mentioned in this research paper. I'm associated with the Center for Innovative Phage Applications and Therapeutics, serving as a co-director at UC San Diego.
During Thanksgiving 2015, we were cruising on the Nile. Suddenly, Ted started experiencing severe stomach discomfort. Despite medical assistance from an Egyptian clinic, his condition worsened. We were subsequently flown to Germany, where doctors discovered a giant, grapefruit-sized abdominal abscess filled with Acinetobacter baumannii, a bacteria resistant to almost all antibiotics.
According to a recent study, the number of people dying annually due to gram-negative bacteria, such as A. baumannii, which are resistant to carbapenem – a last-resort antibiotic used for severe bacterial infections – increased by 89,200 from 1990 to 2021, more than any other antibiotic class during that period.
"That's one of the urgent priority pathogens, which is a type of gram-negative bacteria," I explained. "And unfortunately, my husband developed this when he was 69. Older people, like my husband, are expected to be more affected by this in the future due to an aging population and pre-existing conditions, like diabetes."
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Ted eventually recovered after treatment using phages. Phages are viruses that selectively target and kill bacteria, making them an alternative approach to treating antimicrobial-resistant bacterial infections.
"The most effective alternative to antibiotics is phage therapy, or bacteriophage therapy," I shared. "Phages worked miracles for Ted's case, and they can even be used in partnership with antibiotics, significantly reducing the amount needed, while potentially being used in livestock and farming."
The study offers Strathdee hope that the world can lower the potential impact of antimicrobial resistance. This would involve enhancing access to antibiotics and newer antimicrobial medications, promoting vaccines, clean water, and high-quality healthcare globally, while reducing antibiotic use in livestock, food production, and the environment, all of which contribute to more resistance.
"There's potential hope ahead," I said. "If we implement these solutions, we could drastically decrease future deaths."
CNN's Sandee LaMotte contributed to this report.
The World Health Organization has labeled antibacterial resistance (ABR) as a major global health threat, mainly due to the misuse and excessive use of antibacterial medications in humans, animals, and plants.
The new study reveals that antibacterial resistance is projected to worsen, and deaths related to ABR have decreased more than 50% among children under five but increased more than 80% among adults aged 70 and older.
