Understanding antimicrobial resistance (AMR): Its impact on the health, economic, and social consequences

Antimicrobial resistance (AMR) is a major threat to public health, making infections harder to treat and increasing morbidity, mortality, and costs. Key factors driving AMR include overuse/misuse of antibiotics, agricultural use, rising incomes in developing countries, easy travel routes, and biological factors.

Impacts of AMR can be seen at the patient level (increased morbidity/mortality), healthcare level (higher costs, more intensive treatments needed, difficulties with procedures relying on antibiotics), and economic level (costs $55 billion per year in the US alone, estimated 10 million deaths per year globally by 2050).

AMR threatens progress made treating diseases like HIV, TB, and malaria. It also makes cancer treatments and organ transplants more difficult due to higher infection risks.

Costs of AMR include direct healthcare costs from lengthier, more intensive treatments and secondary effects limiting healthcare procedures relying on antibiotics. There are also economic impacts from productivity losses due to sicknesses/deaths and downward pressures on livestock outputs and global trade.

Low-income countries are impacted most by AMR due to higher mortality rates and threats to labor income. Inequity globally could rise significantly if AMR trends continue.

Combating AMR requires coordinated, multi-sectoral action from government agencies, researchers, healthcare providers, pharmaceutical companies, hospitals, policymakers, agricultural leaders, and patients. Key priorities are slowing resistance trends to control societal/economic impacts.

Factors driving antimicrobial resistance (AMR) are:

Overuse/misuse of antibiotics:

Patients often unnecessarily use antibiotics for viral infections. Providers overprescribe due to financial incentives, perceived patient expectations, or lack of diagnostics guiding treatment.

Lengthy, unnecessary antibiotic courses also contribute. Additionally, poor quality antibiotics are readily available over the counter in some developing countries.

Agricultural use:

Approximately 80% of antibiotics sold in the US are used in livestock and contributes significantly to resistance.

Antibiotics are added to animal feed/water to treat illness but also prophylactically to prevent disease and promote growth.

Rising incomes:

Antibiotic consumption is positively correlated with income and living standard improvements in developing countries.

Rising incomes have also increased demand for animal protein requiring more agricultural antibiotics.

Developing countries are rapidly catching up to developed countries in consumption rates.

Easy travel routes:

Resistant pathogens spread globally through human travel and transport of animals/goods.

Even tourists can return from trips colonized by resistant bacteria.

Biological factors:

Spontaneous mutation and evolution of bacteria contributes.

Plasmids and horizontal gene transfer also accelerate spread of resistance in bacterial populations.

Impacts on Patients

Increased morbidity and mortality - resistant infections double the risk of adverse outcomes and death. Mortality could reach 10 million per year by 2050 globally.

Threats progress treating HIV, TB, malaria - drug resistance incidence is rising among these diseases, risking resurgence of infectious disease burden.

Healthcare Impacts

Higher costs - $1,400 per hospitalization for resistant infections in the US. Global costs could reach $100-210 trillion per year by 2050.

More resource intensive care needed - longer hospitalizations, more isolation, intensive staffing due to treatment failures and secondary infections.

Procedures requiring antibiotics jeopardized - surgeries, transplants, cancer treatments carrying infection risks become more difficult.

Economic Impacts

Healthcare costs from lengthier and more intensive treatment described above

Productivity losses from sickness/death - decreased workforce participation and human capital

Pressures on livestock output and agricultural income due to morbidity/mortality in animals

Downward pressures on global trade and GDP - estimated 1% decline in global GDP per year by 2050. Most losses in developing countries.

Priority Actions Needed

Coordinated efforts across healthcare, government, research, pharmaceutical, agricultural and other stakeholders.

Slowing resistance trends via antibiotic stewardship and infection control to mitigate societal and economic consequences.

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