New Delhi: In 2019, between 3 and 10.4 lakh people in India died due to bacterial antimicrobial resistance (AMR), a condition in which pathogenic bacteria no longer respond to antibiotics, according to the new Global Research on Antimicrobial Resistance (GRAM) Project. The first analysis of the global burden of AMR, the project is a partnership between the University of Oxford and the Institute of Health Metrics and Evaluation (IHME) at the University of Washington.
The findings, published Tuesday in The Lancet, also said that over 39 crore deaths caused directly or indirectly by antibiotic-resistant infections are estimated to occur worldwide by 2050.
The Lancet report added that 29.9 lakh people died in the country either directly from or due to conditions triggered by sepsis—blood poisoning in which the body has an extreme reaction to infection, and whose management has become difficult due to AMR, a widely recognised global public health emergency.
The latest findings come after the annual report by the Indian Council of Medical Research (ICMR)’s Antimicrobial Resistance Research and Surveillance Network (IAMRSN), released last week, which revealed the alarming presence of superbugs—pathogens resistant to multiple antibiotics and extremely difficult to treat—in 21 of the country’s leading hospitals, from 2017 to 2023.
Superbugs have been found in patient samples—blood, urine, and other fluids—collected between 2017 and 2023 from outpatient departments (OPD), wards and intensive care units (ICU) of hospitals including AllMS and Sir Ganga Ram Hospital in Delhi, the Postgraduate Institute of Medical Education and Research (PGIMER) in Chandigarh, and Apollo Hospitals in Chennai, among others.
The Lancet report said that nearly 60 percent of sepsis deaths in 2019 were caused by bacterial infections, while the remaining 40 percent were caused by viruses, fungi and parasites.
As many as 3,25,091 deaths in children under five in the country in 2019 occurred due to bacterial infections, the report said.
The bacteria found to be deadliest to Indian children was Streptococcus pneumoniae, which was associated with 58,212 deaths in 2019.
The report also mentioned that in India, bacterial AMR deaths are associated with or attributable to six major superbugs—Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Acinetobacter baumannii, Mycobacterium tuberculosis, and Streptococcus pneumoniae.
As many as 6,86,908 deaths in India in 2019 were associated (indirectly linked) with these superbugs, and 2,14,461 deaths attributable (directly linked) to them the same year, according to the IHME.
AMR-associated deaths occur due to conditions triggered by drug-resistant infections, and AMR-attributable deaths occur directly as a result of drug-resistant infections left untreated.
The new Lancet report mentioned estimates for 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes (including meningitis, which refers to the inflammation of tissues surrounding the brain and spinal cord; and bloodstream infections) among people of all age groups, in 204 countries and territories.
The estimates were based on 52 crore individual records from a wide range of sources, including hospital data, death records, and antibiotic use data.
The report said that each year between 1990 and 2021, more than 10 lakh people died worldwide as a direct result of AMR. However, in the same period, the total number of AMR deaths globally among children under five declined by 50 percent, while that among people aged 70 years and above increased by more than 80 percent.
It added that each year between now and 2050, about 19.1 lakh people worldwide could potentially die as a direct result of AMR.
Over the same period, the number of global deaths in which AMR bacteria may play a role will increase by almost 75 percent from 47.2 to 82.2 lakh per year, the report said.
While the number of AMR deaths globally among children under five is projected to halve by 2050, that among people 70 years and older may increase twofold, the report added.
The authors noted that the findings highlight a vital need for interventions such as infection prevention, vaccination, minimising inappropriate antibiotic use, and research into new antibiotics to mitigate the number of AMR deaths forecast to occur by 2050.
“Antimicrobial medicines are one of the cornerstones of modern healthcare, and increasing resistance to them is a major cause for concern,” Dr Mohsen Naghavi, one of the authors on the paper, and team leader of the AMR research team at IHME, said in a statement.
“These findings highlight that AMR has been a significant global health threat for decades and that this threat is growing. Understanding how trends in AMR deaths have changed over time, and how they are likely to shift in future, is vital to make informed decisions to help save lives,” he added.
Low- and middle-income countries such as India are particularly vulnerable to AMR, a situation exacerbated by high rates of infectious diseases, increased antibiotic use and the COVID-19 pandemic.
The ICMR report which came out last week said that Escherichia coli was the most commonly isolated pathogen, followed by Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa.
Escherichia coli isolates demonstrated a decrease in susceptibility to most antibiotics (or effectiveness of antibiotics). The bacteria’s susceptibility against antibiotic combination piperacillin-tazobactam dropped to 42.4 percent in 2023 from 56.8 percent in 2017, and that against amikacin to 68.2 percent in 2023 from 79.2 percent in 2017.
Some strains of Escherichia coli naturally present in the human intestine may cause life-threatening complications.
Other superbugs mentioned in the ICMR report also exhibited similar degrees of loss in susceptibility to existing antibiotics.
“The report shows that year after year, susceptibility of priority pathogens to antibiotics is dropping, or resistance against antibiotics is increasing. It means that we are rapidly progressing towards an era where even apparently trivial infections might turn fatal, especially for those who are immunocompromised,” Dr Aravind R, head of the department of infectious diseases at Government Medical College in Thiruvananthapuram, told ThePrint.
“The findings are reflective of the magnitude of AMR in the top-tier tertiary care institutions in India. The picture is alarming and the situation seems to be getting worse year after year,” added Aravind, who is also the convener of the Kerala Antibiotic Resistance Strategic Action Plan.
An ICMR scientist who did not want to be named told ThePrint that the findings may help in the establishment of AMR surveillance networks to capture the resistance trends in primary and secondary care institutions through a hub-and-spoke approach.
“Such stratified antibiograms (table of antimicrobial susceptibility tests for different organisms over a period of time), which reflect resistance at various tiers of health care with respect to tertiary, secondary and primary care centres, are needed to formulate tier-specific antibiotic prescription guidelines and other stewardship interventions,” the scientist added.
