A systematic review published recently by the抗菌阻力合作者reveals the global burden of antimicrobial resistance (AMR) is far greater than the 700,000 deaths per year estimated byWHO and the UN，并将预测的“到2050年AMR造成的100万人死亡”（及其经济影响）更加可信。

在广泛的审查中，抗微生物抵抗的合作者使用了预测性统计建模，并从4.71亿条记录中提取了覆盖204个国家 /地区的隔离物的数据，以估算全球的AMR负担。他们的模型讲述了一个关于AMR负担的非常有趣的故事。

the total global burden of AMR in 2019 was 4.95 million deaths

Perhaps the ‘headline’ of the review is that the total global burden of AMR in 2019 (i.e. pre-COVID) was 4.95 million deaths – and 1.27 million of these were from bacterial AMR alone. If you compare this figure to the approximate 5.9 million deaths worldwide from COVID (2019 to the present date – data from Google), the annual burden of AMR is double. Despite this, the responses to COVID and AMR have been markedly different.

系统的评论继续表明，与许多传染病一样，AMR负担在世界范围内均匀分布：西部撒哈拉以南非洲的死亡率最高，而大洋洲的最低。下图取自系统评价，并显示了负担在地理上最重的位置。

Whilst the models show that sub-Saharan Africa bears a higher AMR burden, actual data and papers covering this region and indeed the whole of Africa are scarce. An initiative to counter that is the Special Collection edited byAlaa Abouelfetouh博士（埃及亚历山大大学）通过监视和能力建设在非洲打击AMR。

Connected to the regional variation is the relationship between wealth and AMR, with poverty increasing the incidence of AMR death. A recent再保险view by Teagan King and colleaguespublished inAntimicrobial Resistance and Infection Control将贫困视为加拿大抗菌抗药性微生物感染的危险因素，并发现感染率基于收入，即使在同一国家内也会显着增加。例如，耐甲氧西林耐药性感染Staphylococcus aureus(MRSA) decreases by 73% for each $100,000 increase in income.

Going back to the Antimicrobial Resistance Collaboration’s paper, they highlight that globally there were six main pathogens that accounted for 73% of all bacterial AMR attributed deaths and 75% of all the AMRassociated2019年的死亡。这些是：E. coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii,和Pseudomonas aeruginosa。这些病原体中的耐药性是一个主要的健康问题，应将更多的资源用于研究，替代治疗和医疗保健能力围绕这些特定病原体。针对这六种病原体将大大减轻AMR负担。

The Antimicrobial Resistance Collaboration put forward 5 steps for reducing the AMR burden:

• Infection prevention and control in both community and health-care settings
• Prevention through vaccine development and administration
• 再保险ducing exposure to antibiotics that are not related to human health (e.g. those use in farming)
• 再保险duce the use of antibiotics in humans when they are not necessary (e.g. in treating viral infections).
• Allocating resources to the development of new antimicrobials

My personal view is that it is the responsibility of governments to take the lead in addressing the threat of AMR. However, it is also the responsibility ofeveryoneto do what they can – even if it is simply finishing the course of antibiotics that have been prescribed to them.