Antimicrobials are essential to eliminate diseases and infections caused by pathogens such as bacteria (antibiotics) or fungi (antifungals), among others. For decades, the former have been overused, which has reduced their effectiveness by promoting the evolution of these microbes to be resistant to them. Between 1990 and 2021, more than a million people died each year worldwide due to drug resistance (AMR).
The future is even worse, it is expected that between 2025 and 2050 this problem will cause 39 million deaths directly and is linked to nearly 170 million. These are the data from the latest Global Burden of Disease (GBD) study published this Monday in The Lancet.
The analysis estimates that 1.91 million people will die that year due to diseases resistant to antimicrobials. Bruno González-Zorn, director of the Antibiotic Resistance Unit at the Complutense University of Madrid (UCM), confirms the concern raised by the figures, but believes that the result can be even worse and these figures can be reached well before 2050.
The professor and WHO advisor says the effect of the covid-19 pandemic must be taken into account. At that time, hospital admissions were higher and these drugs were used more than usual, even though their use in pharmacies was more controlled. “We know that it has accelerated the process”. Another problem with resistant microorganisms is their spread, the expert warns. A patient can even leave the intensive care unit cured after an infection caused by one of these pathogens, but continue to spread it in his environment because he has not finished eliminating it.
[Más de 750.000 muertes al año por resistencia a los antimicrobianos podrían evitarse según un estudio]
The only year the numbers decreased was 2021.. AMR deaths fell from 1.27 million direct deaths in 2019 to 1.14 million two years later. The researchers attribute this decline to the coronavirus crisis. At that time, the burden of non-COVID-19 lower respiratory tract infections was reduced, likely due to social distancing and other disease control measures implemented, they add.
Differences by age
One of the things highlighted in the report is that between 1990 and 2021, AMR deaths in children under five worldwide have decreased by 50%. It is also expected to continue to decline in the coming decades. On the contrary, This data has increased by 80% for the elderly over these three decades and current ones are even expected to double by 2050.
The UCM professor explains that one of the elements to take into account are vaccines. Even though children have a fairly immature immune system, they assimilate vaccines very well and are very effective for them. On the contrary, For the elderly, their protection is less. There are also other factors: with age, the system is increasingly immunocompromised and diseases are more complicated to treat. Likewise, they suffer from other comorbidities that can complicate their clinical condition.
developing countries
The study authors say that deaths directly caused by AMR have increased most in five regions of the world: western sub-Saharan Africa, tropical Latin America, high-income North America, Southeast Asia and South Asia. In these areas, the number of deaths per year increased by more than 10,000 between 1990 and 2021.
It is no coincidence that four of them belong to the group of developing countries. The lack of economic and health resources in these territories makes access to care difficult and promotes excessive use of antibiotics. In fact, in high-income countries, deaths among people aged 70 and over will increase by 72%, while in North Africa and the Middle East will increase by 234%report the authors of the text.
The work highlights that the region most affected by AMR in the future will be South Asia. It is estimated that between 2025 and 2050 there will be 11.8 million deaths directly due to this problemSimilarly, fairly high numbers are expected in the east of the continent and in sub-Saharan Africa.
Spain, one of the worst forecasts
WHO adviser highlights report proposes for Spain one of the worst forecasts in Europe. According to these estimates, in 2050, between 21 and 24 deaths per 100,000 inhabitants would be due to AMR. In the same year, other countries such as the United Kingdom, Germany and France expect figures of between 9 and 18 cases. In 2021, our country recorded between 12 and 15 deaths, making it one of the European territories with the highest increase.
Spain was slow to prevent AMR, the professor regrets. The National Plan to Combat Antibiotics was only implemented in 2014, while Denmark had it since 1996, the expert illustrates. But all is not lost and González-Zorn is optimistic: “Society is becoming more and more aware”There is still a lot of work to be done, but the scientist believes that the country is “on the right track” and will be able to reach the levels of the rest of the European Union.
A difficult task
González-Zorn highlights the interest in evaluating the evolution of something like AMR. Due to the large number of bacteria and different diseases that exist, it is not an easy task. “When studies like this come out, it is because they have been done a sufficiently in-depth and scientific analysis to be able to give figures.”
To do this work, the team made estimates with 22 pathogens, 84 combinations of them with different drugs and 11 infections in people of all ages in 204 countries and territories. In addition, they extracted information from 520 million individual records which included hospital data, death certificates and figures on antibiotic use.
A 2022 study revealed for the first time the true extent of AMR. Global deaths from the problem in 2019 were found to be higher than those caused by diseases such as HIV or malariawhich directly caused more than a million deaths and contributed to an additional 5 million.
How to solve the problem
The very complexity of the situation makes it difficult to intervene to put an end to it. González-Zorn explains that there is no single solution. The measures taken must be individual for each country, taking into account its context. What is clear is that This work must go through education on two levels. On the one hand, doctors and veterinarians must be made aware of the need to reduce the prescription of antibiotics to strictly necessary cases. On the other hand, the population must be made aware of the risks of self-medication and excessive consumption of these drugs.
González-Zorn considers that in society in general There is a lack of awareness on this topic.. He also explains that the Spanish still associate antimicrobials with other drugs such as ibuprofen and aspirin, two commonly used painkillers. Currently, 90% of citizens have antibiotics at home, he points out. “I have proposed that this figure be 0%.”
