Although AMR affects populations in both rich and poor countries, GRAM identified the highest burden levels in low-resource settings. The results confirm that bacterial AMR is a leading cause of death and disability worldwide, with a burden greater than either HIV/AIDS or malaria. GRAM project findings for 2019 show that an estimated 4.95 million people died with a drug-resistant bacterial infection, and that more than 1.27 million of those deaths are directly attributable to AMR. While burden attributable to AMR links resistance directly to health outcomes, burden associated with AMR assumes that resistance may or may not have played a role in death or disability. GRAM provides two separate counterfactual estimates of death and disability from AMR: burden attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and burden associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection). Utilizing data obtained from systematic literature reviews, hospital systems, surveillance networks and other sources, we apply statistical modelling to produce estimates of bacterial AMR burden worldwide.

Our research provides the first comprehensive estimate of AMR burden in 204 countries and territories.

Our research seeks to inform location-specific policy decisions about infection prevention and control, access to antibiotics, development of new drug treatments and vaccines, and other public health matters. Faced with data sparsity, incomplete surveillance, and other challenges, GRAM applies methodologies developed in the ongoing Global Burden of Disease (GBD) study to estimate the impact of drug-resistant bacterial infections on global deaths and disability. Third-generation cephalosporin-resistant Klebsiella pneumoniae by country and territory, 2019GRAM provides a critical measure of global antimicrobial resistance (AMR) for researchers, health practitioners, and policymakers: the global burden of bacterial AMR.

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