Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis

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Summary

Background

Antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen–drug combinations in select locations. To our knowledge, this study presents the most comprehensive estimates of AMR burden to date.

Methods

We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen–drug combinations in 204 countries and territories in 2019. We obtained data from systematic literature reviews, hospital systems, surveillance systems, and other sources, covering 471 million individual records or isolates and 7585 study-location-years. We used predictive statistical modelling to produce estimates of AMR burden for all locations, including for locations with no data. Our approach can be divided into five broad components: number of deaths where infection played a role, proportion of infectious deaths attributable to a given infectious syndrome, proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antibiotic of interest, and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden based on two counterfactuals: deaths attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and deaths associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. We present final estimates aggregated to the global and regional level.

Findings

On the basis of our predictive statistical models, there were an estimated 4·95 million (3·62–6·57) deaths associated with bacterial AMR in 2019, including 1·27 million (95% UI 0·911–1·71) deaths attributable to bacterial AMR. At the regional level, we estimated the all-age death rate attributable to resistance to be highest in western sub-Saharan Africa, at 27·3 deaths per 100 000 (20·9–35·3), and lowest in Australasia, at 6·5 deaths (4·3–9·4) per 100 000. Lower respiratory infections accounted for more than 1·5 million deaths associated with resistance in 2019, making it the most burdensome infectious syndrome. The six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for 929 000 (660 000–1 270 000) deaths attributable to AMR and 3·57 million (2·62–4·78) deaths associated with AMR in 2019. One pathogen–drug combination, meticillin-resistant S aureus, caused more than 100 000 deaths attributable to AMR in 2019, while six more each caused 50 000–100 000 deaths: multidrug-resistant excluding extensively drug-resistant tuberculosis, third-generation cephalosporin-resistant E coli, carbapenem-resistant A baumannii, fluoroquinolone-resistant E coli, carbapenem-resistant K pneumoniae, and third-generation cephalosporin-resistant K pneumoniae.

Interpretation

To our knowledge, this study provides the first comprehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data. AMR is a leading cause of death around the world, with the highest burdens in low-resource settings. Understanding the burden of AMR and the leading pathogen–drug combinations contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics. There are serious data gaps in many low-income settings, emphasising the need to expand microbiology laboratory capacity and data collection systems to improve our understanding of this important human health threat.
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Samantha Bailey

Samantha (Sam) Bailey joined the Biocare team in March as Head of Sales and Business Development and is keen to show the world how BiocareUV products can change our lives.

With over 20 years experience in sales, marketing and business development Sam is excited to utilise her skills at BiocareUV. At the age of 26 Sam was promoted to Sales Director for a £20,000,000 company and has extensive experience working with resellers, distributors and end users in the UK and abroad. She then went on to work in the entertainment industry and spent 8 years expanding her love of international travel, cultures and languages, whilst successfully selling. With French, Russian and Italian under her belt she even spent time in Xian, China, learning Mandarin whilst working for Green Hippo Ltd.

After several years of Global Sales & BD development, ultimately moving to VP level and managing staff both in the UK and abroad, Sam decided to prioritise on her family and took a years sabbatical, after which she owned and ran her own business. Consulting to clients in many sectors and through agencies she has the ability to turn her hand to almost anything.

With operational, technical support, product development and marketing under her belt, Sam is a great asset to the team and brings these skills to the table to complement her Sales & BD role. Sam loves travelling and has spent years doing so in previous positions which gives her a unique insight not only to channel sales but also international business.

Antony Cooper

Antony has been with BiocareUV since March 2021 and is fully equipped to promote and market the brand to audiences worldwide.

Having been a marketeer for over 25 years, Antony trained with the world-renowned agency Saatchi & Saatchi in London.

Antony started his career in a large telecommunications company. He was responsible for both corporate and retail branding across the UK and in over 150 retail outlets.

Managing design teams across large advertising agencies and working on some of the UK’s biggest advertising campaigns, Antony has done it all.

Antony is excited to help bring BiocareUV to industry leaders worldwide and assist with creating a safer environment for all.

Dave Hickson

General / Corporate / Commercial Aviation experience over 44 years. Dave qualified LAME 1978 in New Zealand after apprenticeship National Airways Corporation (Air New Zealand).

Dave setup the Beechcraft Sales / Maintenance facility Ardmore Aerodrome Auckland in 1979 as Chief Engineer and carried out a number of Beech King Air ferry flight deliveries to Large corporations operating in NZ and Australia as Co-Pilot Engineer as part of Beechcraft development in NZ.

In 1981 Dave moved to Perth Western Australia to take a position with Skywest Airlines as LAME working on Corporate Jet and Regional Aircraft types.

1984-1988 Dave worked for Air Rarotonga, Cook Islands as Chief Engineer.

1989-1991 Dave moved to the UK starting at Qualitar as LAME Hanger 6 Manchester Int Airport.

1991-1997 FFV Aerotech / FLS Aerospace Manchester Dave worked as LAME Airframe/Engine and held company approvals on the following Aircraft types: B747-100,-200, SP, B757-200, MD 83, MD 82, Airbus A300, A320, A32, A319. Engines: RB211-C, E4, P&W JT9D, 2000, IAE V2500, CFM56. Dave was specialist A320 support engineer for the Company and managed the Airbus Heavy maintenance projects.

In 1995 Dave was promoted to Hanger Manager responsible Fleet Maintenance contract for Air 2000 and Air World.

1997 to present Dave has operated his own companies specialising in Repair/Refurbishment of Commercial Aircraft Cabin Interiors / IFE and development of Specialised Biocidal Chemicals for Cabin Sanitation and Water Filtration.

Aerocare is a Global Service provider and has worked for Major Scheduled Airlines, Charter Airlines and Leasing Companies providing total Cabin solutions, VIP Installations including IFE systems integration. Aerocare capability extends to manufacture of Bespoke upgrades in all Cabin Environments. Aerocare has been involved in a number of high profile VIP Cabin Developments for SilverJet B767, Air Macau A319, TAG FourSeasons B757-200, Saudi Private Aviation A319.

The Company has EASA 145/FAA 145, EASA 21G approvals and Dave is Accountable Manager for Aerocare International.

Aerocare more recently introduced a Corporate Jet Business to the Group in 2017 having acquired Hawker/Beechcraft business vacated by Marshall Aerospace at Chester Howarden Airfield.

Aerocare will provide servicing for Netjets and Hawker Private owners having passed CAA Audit 6-7th June 17. Aerocare will support Hanger Operations from Warrington for Workshops and the business will be heavily focused on development for Special Missions Modifications.

Adrian Leatherland

Adrian has been in the aviation and aerospace business for over 30 years.

Starting as a graduate apprentice with the Dowty Group in 1986, Adrian initially worked as an Avionics Systems Engineer for over 10 years on military and civil projects including Tornado, A320, Typhoon and A340.

Adrian has worked in many sectors of aviation and aerospace developing relationships with Airlines, Operators, OEMs, MROs and aviation support companies including SAS, Lufthansa Technik, Jet Aviation, KLM, Airbus, SR Technics, Rockwell Collins, Fokker Techniek, Elbit Systems, RUAG, Aerocare and Honeywell.

Examples of project management experience include establishing an EASA Part 147 Technical Training facility working with Lufthansa Technik and the development of a UAV Training Simulator working with Elbit Systems. Recently, Adrian has successfully project managed two Innovate UK Projects with Aerocare to demonstrate the effectiveness of Far UV Technology in a variety of settings using specifically designed Far UV devices. This included working with The University of Manchester and Wrexham Glyndwr University as well as London Gatwick Airport to develop equipment and trials to demonstrate the use of Far UV technology in real world applications.

Mike Humphreys

Mike joined Aerocare Aviation Services as the Special Missions Marketing Director in September 2017 and was responsible for starting BiocareUV in early 2020 as the Coronavirus crisis took hold.

Mike left the RAF after 23 years as a Tornado fast-jet navigator, weapons instructor and UAV Test Squadron Commanding Officer. His final 9-month tour was undertaken in Afghanistan as the NATO/ISAF Chief of Dynamic targets, during which time he was awarded the NATO Meritorious Service Medal. He joined BAES in 2009 as their Unmanned Air Vehicle (UAV) Requirements Manager where he was responsible for systems and capability development of the companies’ family of UAVs, including the HERTI, MANTIS and TARANIS systems. His time there included operating as a UAV Commander with deployed teams in various locations including the Middle East and Australia.

Mike joined Blue Bear Systems Research in 2012 as the Global Business Development & Account Manager, responsible for Strategy and the companies’ nascent synthetic development capability and maritime unmanned systems, delivering both an autonomous unmanned surface vessel and accompanying maritime synthetic environments to the UK MoD, and spent 3 years at the Marshall Aerospace and Defence Group as their Special Missions Marketing Director until joining AAS and building BiocareUV as a start-up.

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