Study: An estimated 3 million children died of AMR-associated complications in 2022

Key takeaways:

• An estimated 3 million children died from AMR-associated complications in 2022.
• Africa and Southeast Asia had the highest mortality burden.

VIENNA — An estimated 3 million children died from antimicrobial resistance-associated complications in 2022 across the globe, most of whom lived in Southeast Asia and Africa, according to findings presented at ESCMID Global 2025.

Joseph Harwell, MD, Senior Clinical Director at Clinton Health Access Initiative and associate clinical professor of medicine and pediatrics at Brown University’s Warren Alpert Medical School, told Healio he is concerned about rising rates of resistance to antibiotics for treating sepsis and respiratory infections.

Harwell and Yanhong Jessika Hu, MD, MPH, PhD, an honorary senior research fellow at Murdoch Children’s Research Institute at University of Melbourne, Australia, investigated antimicrobial resistance (AMR)-related pediatric deaths in 83 countries from 2004 to 2022. They studied 106,581 isolates from Pfizer’s ATLAS and the Global Burden of Disease study to identify patterns and estimate annual mortality rates.

Nearly half of the isolates came from children aged younger than 2 years (47%), according to the authors. They noted that most came from sputum (30%), wounds (20%), blood (16%) and urine (12%).

Harwell and colleagues estimated that 3 million children — including 752,000 in Southeast Asia and 659,000 in Africa — died from AMR-related complications in 2022, according to a related press release.

The researchers also categorized data based on whether the antibiotics were in the WHO’s Access, Watch or Reserve groups.

According to WHO, “Access” antibiotics are narrower spectrum and carry a lower risk for resistance and, therefore, should be available at all times. “Watch” antibiotics are broader spectrum drugs indicated for severe infections and those suspected of having resistance, but they should be used sparingly because of their higher risk for developing resistance. “Reserve” antibiotics are broad spectrum last-resort drugs; WHO recommends using them only to treat life-threating infections caused by multidrug-resistant bacteria.

In their 2022 estimate, the researchers said 2 million AMR-related deaths were associated with Watch and Reserve antibiotics.

Harwell and colleagues reported that the use of Watch antibiotics rose 160% in Southeast Asia and 126% in Africa from 2019 to 2021, and Reserve antibiotic use increased 45% in Southeast Asia and 125% in Africa. Reserve antibiotic use also rose 44% in Europe during that time frame.

Harwell noted that although the relative increase use seems large, the absolute increase in Africa is small. He also pointed out that global antibiotic use rose during the COVID-19 pandemic, so perhaps providers were using alternative antibiotics because the preferred antibiotics were in short supply.

“It is tempting to assume the rise in resistance is because of the rise in use, but especially because the actual volumes of use of Reserve antibiotics are so small, one would not expect that to be the case,” he said.

The researchers reported that global rates of resistance to Watch and Reserve antibiotics rose sharply during the COVID-19 pandemic, especially for bloodstream and respiratory infections Additionally, Escherichia coli was 30% resistant to access antibiotics, and Klebsiella pneumoniae and Enterobacter cloacae became more resistant to watch and reserve antibiotics over time.

In Africa and Southeast Asia, the authors found combined resistance to ampicillin and gentamicin exceeded 40%. This combination is the preferred initial treatment for severe infections in young children. Harwell said the high rates of resistance to both drugs in areas with high mortality is something that needs further attention.

Harwell offered suggestions to reduce AMR-related deaths, noting that the best way to avoid AMR-related deaths is by preventing infections in the first place through immunization and improved sanitation. He recommended, however, that improving infection prevention and control in health care facilities, enhancing diagnostics and treatment and preventing unsupervised antibiotic use could also curb the risk of AMR.

“Providers should recognize that effective antibiotics are a precious commodity and should be used correctly,” Harwell said. “This means that the importance of using antibiotics responsibly must be highlighted for caregivers before a child experiences a condition that might lead to a desire to use antibiotics.”

For more information:

Joseph Harwell, MD, can be reached at communications@clintonhealthaccess.org.

References:

• Hu Y, et al. Abstract 00829. Presented at: ESCMID Global; April 11-15, 2025; Vienna.
• Over 3 million children died from AMR-related infections in 2022, major study shows. https://www.eurekalert.org/news-releases/1079367. Published April 13, 2025.