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More than 39 million people are likely to die from antibiotic-resistant infections by 2050, according to an in-depth global analysis of antimicrobial resistance published recently in The Lancet.
The research has found that more than one million people died from drug-resistant infections each year between 1990 and 2021, and this could increase to nearly 2 million by 2050.
Around 92 million lives could be saved between 2025 and 2050 with wider access to appropriate antibiotics and better treatment of infections, says the study published on September 16.
Regions with the highest predicted mortality rates include South Asia, Latin America and the Caribbean, and researchers emphasise that any strategies to tackle drug resistance must prioritise low- and middle-income countries.
"We need more global investment and a lot more real interactive engagement with low-income countries to make sure that they are equipped," says Timothy Walsh, a microbiologist at the University of Oxford.
Strategies must ensure that hospitals in low-income countries have access to diagnostic tools, antibiotics, clean water and sanitation, he adds.
"This is an important contribution to understanding how we've gotten where we are, and for giving a rational expectation of the future burden of [resistance] in order to inform next steps that can be undertaken," says Joseph Lewnard, an epidemiologist at the University of California, Berkeley.
"I think the burden numbers are probably much higher than what has been reported here," particularly in countries where there are data gaps, says Walsh.
The figures suggest that the world is failing to meet the United Nation's target of reducing mortality caused by antimicrobial resistance by 2030.
Researchers analysed mortality data and hospital records from 204 countries for 1990 to 2021, focusing on 22 pathogens, 84 combinations of bacteria and drugs they are resistant to and 11 diseases, including blood infections and meningitis.
Their findings reveal that although the number of children aged under 5 dying from drug-resistant infections has fallen by more 50 per cent over the past 3 decades, mortality rates in people aged over 70 have increased by 80 per cent.
Many of the deadliest infections between 1990 and 2021 were caused by a group of bacteria with particularly strong drug resistance, called gram-negative bacteria. This category includes Escherichia coli and Acinetobacter baumannii - a pathogen associated with hospital-acquired infections.
Gram-negative bacteria are resistant to Carbapenem drugs, a class of antibiotics used to treat severe infections, and they can exchange antibiotic-resistance genes with different species as well as passing them to offspring.
Deaths linked to Carbapenem-resistant gram-negative bacteria have risen by 149.51 per cent, from 50,900 cases in 1990 to 127,000 cases in 2021.
The report estimates that antimicrobial resistance could cause 1.91 million deaths each year by 2050, and that a further 8.22 million people will die from illnesses associated with resistance.
"This study shows we have a problem in health-system quality and prevention of infections," says co-author Mohsen Naghavi, a physician and epidemiologist at the University of Washington in Seattle.
Policymakers should also address the overuse of antibiotics in farming, which speeds up bacterial resistance, and invest in research for innovative antibiotic drugs, Walsh says.