Two ways of counting
Researchers report the burden of AMR in two ways. Deaths attributable to resistance are those that would not have happened if the infection had been drug-susceptible — the direct toll. Deaths associated with resistance count everyone who died with a resistant infection playing some role. The truth lies between the two; both numbers are enormous.
A leading cause of death worldwide
Set against other major infectious killers in the same year, the direct AMR death toll in 2019 exceeded both HIV/AIDS and malaria — diseases that command dedicated global funds and decades of coordinated response.
Global deaths in 2019: AMR versus other major infectious causes
Millions of deaths; AMR bar shows deaths directly attributable to bacterial resistance (GRAM Project, The Lancet)
Counting all deaths merely associated with resistance (4.95M) would place AMR among the top three causes of death globally, behind only heart disease and stroke.
The burden is deeply unequal
AMR is often pictured as a rich-world hospital problem. The data show the opposite: death rates are highest where health systems are weakest.
- Sub-Saharan Africa and South Asia carry the highest death rates. In western sub-Saharan Africa the attributable death rate reached about 27 deaths per 100,000 people in 2019 — roughly four times the rate in Australasia (about 6.5 per 100,000).
- The poorest are hit through a double burden: more infections (due to weaker water, sanitation and vaccination coverage) and less access to the second-line drugs needed once resistance strikes. Lack of access to any effective antibiotic still kills more people in these regions than resistance itself.
- In 2019, roughly one in five deaths attributable to AMR was in a child under five — often from previously treatable infections such as pneumonia and bloodstream infections.
Shifting age patterns
The 2024 GRAM analysis, covering 1990–2021, found two opposing trends: deaths from AMR among children under five fell by about 50% over three decades — thanks to vaccines, cleaner water and better child health care — while deaths among adults over 70 rose by more than 80%, as populations age and more care involves hospitals, surgery and immune-suppressing treatment. When children do get infections now, however, those infections are more likely to be resistant.
The pathogens doing the damage
Just six bacteria account for the majority of the toll. Together, in 2019, they were responsible for around 929,000 deaths directly attributable to resistance and 3.57 million associated deaths:
- Escherichia coli — urinary tract, bloodstream and gut infections
- Staphylococcus aureus — skin, wound, bone and bloodstream infections; MRSA alone directly caused more than 100,000 deaths in 2019
- Klebsiella pneumoniae — pneumonia and sepsis, especially in hospitals and newborns
- Streptococcus pneumoniae — pneumonia and meningitis
- Acinetobacter baumannii — ventilator-associated pneumonia and wound infections in intensive care
- Pseudomonas aeruginosa — infections in burns, cystic fibrosis and immunocompromised patients
Snapshot: the United States
Even in a high-income system, the US CDC counts more than 2.8 million antimicrobial-resistant infections and over 35,000 deaths every year. Progress made against hospital superbugs during the 2010s was partly reversed by the COVID-19 pandemic, when resistant hospital-onset infections and deaths rose about 15% in 2020.
Bottom line
AMR is not a future threat — it is a present, measurable, leading cause of death, comparable to the biggest infectious diseases in history, and concentrated among the world's poorest and its very young and very old.
Sources for this page
- Murray et al., “Global burden of bacterial antimicrobial resistance in 2019”, The Lancet, 2022 — thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext
- University of Oxford, “An estimated 1.2 million people died in 2019 from antibiotic-resistant bacterial infections”, 2022 — ox.ac.uk/news
- GBD 2021 Antimicrobial Resistance Collaborators, The Lancet, 2024 — thelancet.com/journals/lancet/article/PIIS0140-6736(24)01867-1/fulltext
- CDC, “Antibiotic Resistance Threats in the United States, 2019” and “COVID-19: U.S. Impact on Antimicrobial Resistance, 2022” — cdc.gov