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A massive treatment gap is leaving millions vulnerable to untreatable infections in low- and middle-income countries, as new data shows a dire shortfall in access to life-saving antibiotics. Study: Estimated undertreatment of carbapenem-resistant Gram-negative bacterial infections in eight low-income and middle-income countries: a modelling study. Image Credit: Shutterstock AI Generator / Shutterstock.
com A recent Lancet Infectious Diseases study investigated the total number of carbapenem-resistant Gram-negative (CRGN) bacterial infections in low—and middle-income countries (LMICs) that require active treatment and the actual number of patients receiving treatment. The persistent threat of antimicrobial resistance Antimicrobial resistance (AMR) has become a major global health threat, as it accounts for approximately 1.1 million deaths annually worldwide.
As compared to high-income countries, a significantly higher number of AMR-related deaths has been estimated from LMICs. In fact, one study recently reported that a child born in Africa is 58 times more susceptible to dying from drug-resistant infection in the first five years of life as compared to a child born in a high-income country. If bacterial drug resistance rates continue to increase without any effective remedy, researchers predict that nearly 40 million cumulative deaths will occur globally by 2050.
To mitigate the threat of AMR, the United Nations General Assembly, along with many national governments worldwide, including LMICs, have developed several strategies to expand antibiotic access and support antibiotic innovation. These efforts can potentially reduce mortality rates associated with AMR by improving the accuracy of infection diagnoses and providing appropriate antibiotic treatment. It remains unclear whether AMR infections are effectively treated in LMICs and how the presence of any external barriers may compromise the prompt administration of antibiotic therapy to these patients.
This information will provide important insights into how bacterial infections are managed in LMICs. About the study The current study used a computational modeling strategy to assess the burden and treatment of CRGN bacterial infections in eight large LMICs, including South Africa, India, Brazil, Kenya, Mexico, Pakistan, Egypt, and Bangladesh. The total number of patients in LMICs with CRGN bacterial infections requiring treatment was estimated.
The number of patients who died in 2019 from CRGN bacterial infection was calculated based on the Global Research on Antimicrobial Resistance (GRAM) study between 1990 and 2021 from the selected eight countries. The GRAM study used specific CRGN bacterial pathogens, such as Acinetobacter baumannii, Enterobacter spp, Klebsiella pneumoniae, Pseudomonas aeruginosa, Citrobacter spp, Escherichia coli, and Serratia spp. Data from the GRAM study were adjusted to quantify deaths from CRGN bacterial infection accurately.
The overall fatality rate for CRGN bacterial infections was assessed by pooling available estimates from published literature. The researchers also estimated the total number of individuals who received appropriate treatment. The sales volume of the antibiotics such as colistin, ceftazidime-avibactam, ceftolozane-tazobactam, polymyxin B, and tigecycline against CRGN bacteria was also considered.
Study findings A total of 478,790 CRGN bacterial infection-related deaths and 1,496,219 CRGN bacterial infections that required antibiotic treatments were documented, most of which occurred in South Asia, particularly India. Although Kenya and South Africa reported the lowest CRGN bacterial infections, these two countries were the least populated. Considering the large number of CRGN bacterial infections in the selected countries, only 103,647 antibiotic courses effective for CRGN bacterial infection treatment were procured in 2019.
These estimates imply a potential treatment gap of 1,392,572 patients, which reflects 6.9% of patients receiving appropriate treatment. Similarly, Mexico and Egypt procured antibiotics to treat 14.
9% of their estimated patients. Although India procured most of the studied antibiotics, this nation only accounted for 7.8% of the total need.
Bangladesh, Pakistan, and South Africa procured 1.0%, 3.5%, and 7.
0%, respectively, of the antibiotics needed. The lowest antibiotic procurement was observed in Kenya and Brazil by 0.2% and 0.
4% of their total requirement, respectively. Except for Mexico and Pakistan, all other LMICs primarily procured tigecycline and colistin, whereas ceftazidime-avibactam was the least procured. Mexico and Pakistan more commonly procured fosfomycin and tigecycline.
None of the countries obtained meropenem-vaborbactam for treatment. Mexico, India, and Brazil procured at least four different antibiotics, whereas South Africa, Bangladesh, and Kenya acquired two or fewer. All estimates were validated through robustness tests.
A significant gap was observed between the total number of CRGN bacterial infection cases and treatment. Inadequate access to appropriate treatment undoubtedly increases morbidity and mortality for patients with CRGN bacterial infections, compounding the effects of antibiotic resistance .” Conclusions The current study indicated that CRGN bacterial infections are significantly undertreated in LMICs.
Improved access to diagnostics and antibiotic treatment could reduce the gap between the total number of infections and treatment. In the future, appropriate policies must be developed to address the gap, and more research is required to identify the treatment pathways in LMICs. Mishra, A.
, Dwivedi, R., Faure, K., et al .
(2025) Estimated undertreatment of carbapenem-resistant Gram-negative bacterial infections in eight low-income and middle-income countries: a modelling study. Lancet Infectious Diseases . doi:10.
1016/S1473-3099(25)00108-2.
