https://hull-repository.worktribe.com/preview/1797952/1-s2.0-S0140673618322797-main.pdf

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

世界経済・社会統計 = World development indicators

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61729-2.pdf

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017

https://digital.library.adelaide.edu.au/dspace/bitstream/2440/104804/2/hdl_104804.pdf

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

there was an increase in morbidity and length of stay, but there was no signif­ icant increase in mortality due to mul­ tidrug­resistant (MDR) or extremely drug­resistant gram­negative bacterial infection [3]. India is the largest consumer of antibi­ otics, but human use accounts for the mi­ nority of the total antimicrobial products consumed, with the majority of antibiot­ ics being used as growth enhancers in the food animal sector [4]. Although there are strict guidelines on nonutilization of im­ portant human antibiotics, for example, colistin in the food animal sector, there is widespread belief and evidence that these are regularly ignored, resulting in increas­ ing transmission of AMR from farms to hospitals. This has put increasing pressure on regulatory authorities to ban the use of antibiotics in the animal section in the hope of saving them for clinical use [5]. This overutilization has been shown to be responsible for increasing AMR. In India, infections caused by MDR organisms are very frequent, often result­ ing in mortality due to a paucity of treat­ ment options [6]. To address these issues, the Indian Council of Medical Research initiated a nationwide Antimicrobial Resistance Surveillance and Research Initiative (AMRSRI) in 2016. The aim of AMRSRI is to provide reliable and au­ thentic estimates of AMR burden encom­ passing local resistance patterns as well as molecular epidemiology of isolates throughout the country as this data will be invaluable in guiding national policy. AMRSRI has subsequently released an­ nual reports that detail the various resis­ tances encountered in clinical isolates nationally [7]. Collectively, Gandra et al’s report on mortality due to AMR is a welcome step to gauge the effect of AMR on mortality rates in India. This issue is projected to cost the global economy $100 trillion and result in 10 million deaths by 2050 [8]. In order to more accurately represent the effect of AMR on mortality, data from AMRSRI and other initiatives should be collated, along with data from private healthcare providers. Additionally, there should be stringent implementation of antibiotic stewardship and infection con­ trol programs in the healthcare sector and nonutilization of important human antibiotics in the farm and animal hus­ bandry sector as growth promoters. Research aimed at understanding the genetic and molecular basis of AMR in MDR organisms as well as novel drug discovery and development should be declared a national priority as AMR does not respect international boundaries.

/pdf/reply-to-chopra-and-rizvi-4dyl77samq.pdf

Ramanan Laxminarayan

Papers

Reply to Chopra and Rizvi.