A report today from a multidisciplinary panel of Canadian researchers estimates that 15 Canadians died each day last year as a direct result of antibiotic-resistant infections.

And unless action is taken to address rising antimicrobial resistance (AMR), that number will grow substantially in the coming years, with additional impacts to the country's economy and quality of life, the panel concludes.

The report from the Council of Canadian Academies (CCA), titled "When Antibiotics Fail," found that an average of 26% of bacterial infections reported in Canada in 2018 were resistant to first-line treatment, with 14,000 deaths linked to those infections and 5,400 deaths directly attributable to antibiotic resistance. Longer hospital stays and longer courses of treatment associated with drug-resistant infections cost the Canadian healthcare system more than $1 billion (in Canadian dollars), and the resulting impact on labor productivity cost the country's economy $2 billion.

If the rate of antibiotic resistance climbs to 40% by 2050, the panel estimates that 13,700 people will die each year from drug-resistant infections, Canadian hospitals will spend an additional $7.6 billion annually, and the economy will lose $21 billion a year.

"AMR is a looming public health threat and potential economic disaster in Canada," the panel concludes.

Impacts on health and the economy

The panelists, a group that included experts in public health, infectious diseases, microbiology, veterinary health, economics, and sociology, based their findings on various sources of health, social, and economic evidence, drawing from peer-reviewed publications and government statistics. Their ultimate goal was to assess the socioeconomic impact of AMR for Canadians and the Canadian healthcare system.

Rather than examining the impact of certain pathogens, they chose to focus on 10 important clinical syndromes that they believe encompass the majority of drug-resistant infections in Canada: bacterial gastrointestinal infections, bloodstream infections, Clostridiodes difficile infections, intra-abdominal infections, musculoskeletal infections, pneumonia, sexually transmitted infections, skin and other soft-tissue infections, tuberculosis, and urinary tract infections.

"While these 10 syndromes do not represent all resistant microbes that infect people in Canada, in the Panel's experience, they do represent the majority of cases," the report states. Published data were used to estimate the percentage of these infections that were resistant to one or more first-line antibiotics and the percentage of infections that led to death.

Based on these 10 syndromes, the panel estimates that Canadians acquired 980,000 bacterial infections in 2018, and 250,000 (26%) were resistant to first-line treatment. The average mortality rate for drug-resistant infections was 5.6%, and patients with resistant infections spent an extra 880,000 days in the hospital. The report concludes that 4 out of every 10 deaths from a resistant infection would not have occurred if the infection was susceptible to first-line treatments.

The panel further projects that if treatment recommendations don't change and resistance rates continue on their current trajectory, a resistance level of 40% by 2050 is reasonable, and could even be an underestimate. And if that holds, an estimated 396,000 deaths a year will be linked to drug-resistant infections

Calculations of healthcare costs associated with AMR, based on studies of the average cost of treating the 10 clinical syndromes when caused by methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria, and C difficile, found that patients with resistant infections cost roughly $18,000 to treat. The most expensive infections to treat were tuberculosis, urinary tract infections, intra-abdominal infections, and bacterial gastrointestinal infections.

Together, these infections cost the Canadian healthcare system $1.4 billion, which represents 0.6% of national healthcare spending. And if resistance rises to 40%, the associated costs would increase to between $5.5 billion and $7.6 billion a year, accounting for nearly 1% of healthcare spending.

"Such a major increase in one dimension of healthcare would put significant financial strain on the rest of the system, perhaps resulting in spending cuts elsewhere in the health system or in government services," the panel writes.

And the costs of AMR were felt beyond the healthcare system. Using a qualitative economic model to explore the relationship between resistance, health, labor productivity, agriculture, and trade, the panel estimates that the effect of death and illness from drug-resistant infections on the country's working population reduced Canada's gross domestic product by $2 billion in 2018, with 50% of the decline in economic activity occurring in the most labor-intensive fields: recreation and culture, transportation, and public services.

If resistance rates continue to rise, the panel estimates that the resulting reduction in the labor supply could reduce Canada's GDP from $13 billion to $21 billion a year in 2050. Cumulatively, the country could lose up to $388 billion from 2018 through 2050.

A socioeconomic issue

But the report also warns that AMR will have profound impacts beyond healthcare and the economy, and could eventually begin tearing at the country's social fabric. As infections become more resistant to treatment and access to antibiotics becomes limited, people may start avoiding needed healthcare, quality of life will decline, people who are suffering from or at risk of drug-resistant infections may become stigmatized, and isolation and inequality will rise.

And while these impacts will affect all Canadians, certain populations—older adults, infants, people living in impoverished and overcrowded conditions, people with existing diseases, and indigenous populations—will be hit hardest, further increasing social inequality.

Moreover, the report warns that the consequences will spread beyond patients. Using the 2003 SARS (severe acute respiratory syndrome) outbreak as an example, the panel suggests Canadians could start avoiding activity outside their homes to limit human contact. They may also become less likely to travel, more supportive of closing the country's borders, and less trusting of the government.

Brett Finlay, PhD, chair of the panel and a professor at the University of British Columbia, warns that unless Canada acts to address rising antibiotic resistance, the country will be "greatly changed within a few decades."

"The economy will shrink, the healthcare system will be less sustainable, and social inequality will further increase," Finlay writes in the report. "It is clear that AMR needs not only to be seen as a scientific and healthcare issue, but also as an economic and security threat. It is an insidious problem that increasingly permeates all aspects of our society."

To address the threat, the panel calls for a globally coordinated, multifaceted approach that focuses on four mitigation strategies—surveillance, infection prevention and control, antibiotic stewardship (in both human and veterinary medicine), and research and innovation.