Burden of bacterial antimicrobial resistance associated with modifiable human antibiotic consumption: An observational study

A study published in 2023 assesses the burden of bacterial antimicrobial resistance (AMR) linked to human antibiotic consumption. The research, led by Benjamin J. Singer and colleagues, analyzed data from 2000 to 2018 covering more than 30 million bacterial isolates collected from 114 countries. The team examined antibiotic consumption, categorized into seven drug classes, while adjusting for various health and development indicators within the countries using weighted regression models.

The researchers focused on 16 bacterial pathogens, finding the strongest association between AMR and population-wide antibiotic exposure in Acinetobacter spp., Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. If antibiotic use across all classes were reduced by 10% compared to the present levels, it would potentially lead to 38,000 fewer annual deaths worldwide due to AMR (95% confidence interval: 36,000–41,000). This reduction, however, represents only 0.50% of the estimated bacterial disease mortality.

Sub-Saharan Africa, a region where the risk of death from bacterial diseases is most significant, would experience an avertable burden of AMR-attributable deaths only accounting for 0.34% of bacterial disease mortality. The study's limitations include the reliance on ecological relationships to infer the impact of modifiable factors and the limited representation of low-resource settings in the available surveillance data on antibiotic consumption and AMR prevalence.

The study's findings imply that achieving substantial reductions in AMR-attributable deaths is likely to be modest in the short term compared to the ongoing burden of bacterial disease mortality. These insights should be taken into account when evaluating the potential benefits and drawbacks of restricting or permitting antibiotic use in different epidemiological settings.