In what may be the first estimate of bacterial deaths worldwide, researchers found that 33 bacterial pathogens were responsible for more than 1 in 7 deaths in 2019, and 5 pathogens were among those. reported to be associated with just over half of the deaths.
“Deaths associated with these bacteria will be the second leading cause of death worldwide in 2019.” ischemic heart diseaseprincipal investigator Mohsen Nagavi, M.D., Ph.D., University of Washington, Seattle, and host of GBD 2019 Antimicrobial Resistance Collaborators, wrote:
Survey results, publish online Today’s lancetpoint to Staphylococcus aureus Leading cause of bacterial death in 135 countries Streptococcus pneumoniae Children under the age of five have the highest mortality rates.The other three most clinically important pathogens are Escherichia coliKlebsiella pneumoniae, When Pseudomonas aeruginosa.
Research estimated Staphylococcus aureus It was associated with more than 1 million deaths globally in 2019, compared to more than 500,000 each of the other four pathogens.
“This study can be used to guide strategies to reduce the burden of bacterial infections, including infection prevention and control measures, vaccine development and delivery, and the availability of basic acute care services.” writes the authors.
33 pathogens, 204 countries, 11 infectious syndromes
In this study, we estimated the fatal burden associated with infections caused by 33 bacterial species or genera across 204 countries or territories and 11 infectious syndromes.Researchers included, but excluded, antibiotic-resistant and susceptible bacteria mycobacteria tuberculosisthey write, because it is already a major focus of global public health initiatives.
Researchers used data derived from death certificates, hospital discharge records, mortality studies, literature reviews, microbial data, and extrapolations from the Global Burden of Disease, Injury, and Risk Factors Research.
In three modeling steps, they estimated:
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Total number of deaths in which infection played a role
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Infectious disease syndrome responsible for these deaths
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Pathogens associated with these infectious syndromes
“Infectious disease syndrome is the direct causative infection of sepsis and acts as a bridge between the underlying cause of death and sepsis,” the authors explain.
The 3 syndromes responsible for most deaths were lower respiratory infections, bloodstream infection, and peritoneal and intraperitoneal infections. The syndromes responsible for most deaths varied by location.
Overall, lower respiratory tract infections were responsible for 4 million deaths, bloodstream infections for 2.91 million deaths, and peritoneal and intraperitoneal infections for 1.28 million deaths.
“There was considerable variability as to which pathogens were most prevalent in different infectious syndromes,” the authors note. pneumococcus leading cause of fatal lower respiratory tract infections (653,000 deaths), Staphylococcus aureus leading cause of fatal bloodstream infections (299,000 deaths), and Escherichia coli It is the leading cause of fatal peritoneal and intra-abdominal infections (290,000 deaths).
There was “substantial variability” in the burden of bacterial infections across regions, with “the impact of both gram-positive and gram-negative pathogens clearly seen”, with the highest number of deaths occurring in sub-Saharan Africa. The various burdens in sub-Saharan Africa are magnified by the burden of substantial years of life lost (YLLs) in the region, they added.
Overall, age-standardized mortality rates associated with these bacterial pathogens were highest in sub-Saharan Africa (230 per 100,000 population) and lowest in high-income regions (100,000 population). 52.2 per person).
“By estimating mortality and YLL for a wide range of pathogens and infectious syndromes, we have created a global account of a hitherto unknown and possibly underestimated bacterium,” they said.
Few public health precautions
Of the five most clinically important pathogens they identified, pneumococcus They are the focus of global surveillance and public health initiatives, writing that others are “not the primary focus of global public health initiatives.”
Investigators highlighted four interventions to address the burden of these bacterial pathogens.
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Infection prevention
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vaccination
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Adequate acute care services, including “timely access to appropriate antibiotics, microbiological competence to identify the causative agent of infection, and provision of supportive care.”
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“Strategic approach and substantial investment in the development of new and effective antibiotics”
The study investigated both antimicrobial-susceptible and resistant pathogens, but antimicrobial resistance (AMR) is the “weakest link” threatening “modern medicine and public health as a whole.” Published Perspective Oxford University, Oxford, UK, Mahidol University, Bangkok, Thailand, and one week before PLoS Biology by colleague Christiane Dolecek, MD, PhD.
Both Dolecek and Naghavi, along with Antimicrobial Resistance Collaborators, contributed to the GRAM Report, a systematic analysis of the global burden of antimicrobial resistance in 2019. It was published earlier this year lancetThey estimated that AMR contributed to 4.3 million deaths, directly contributing to 1.27 million deaths that year.
“The main principles for combating bacterial drug-resistant infections are well defined and agreed upon … but their implementation is proving to be much more difficult,” says editor Dolecek and colleagues. is writing
“There is still much work to be done — especially in wealthy countries, to encourage antibiotic stewardship, research and innovation (R&I), and to support pull mechanisms to decouple antibiotic development from sales volumes. However, the reality of many lower and middle income groups points out that countries lack the dedicated resources for the actions necessary to implement these plans, jeopardizing their implementation.”
They stressed that “we are on a disastrous trend” and concluded that “AMR must be urgently refocused or more and more precious lives will be lost.”
The Global Burden of Disease Study was funded by the Bill & Melinda Gates Foundation, the Wellcome Trust, and the Department of Health and Human Services using UK grant funds managed by the Fleming Foundation. The GRAM project is funded by the UK Department of Health and Human Services’ Fleming Fund, the Wellcome Trust and the Bill and Melinda Gates Foundation. The study authors and editors did not report any relevant financial relationships.
lancet. Published online on November 21, 2022. full text
Kate Johnson is a Montreal-based freelance medical journalist who has written on all areas of medicine for over 30 years.
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