National action plans enumerate many interventions as potential strategies to reduce the burden of bacterial antimicrobial resistance (AMR). However, knowledge of the benefits achievable by specific approaches is needed to inform policy making, especially in low-income and middle-income countries (LMICs) with substantial AMR burden and low health-care system capacity. In a modelling analysis, we estimated that improving infection prevention and control programmes in LMIC health-care settings could prevent at least 337 000 (95% CI 250 200–465 200) AMR-associated deaths annually. Ensuring universal access to high-quality water, sanitation, and hygiene services would prevent 247 800 (160 000–337 800) AMR-associated deaths and paediatric vaccines 181 500 (153 400–206 800) AMR-associated deaths, from both direct prevention of resistant infections and reductions in antibiotic consumption. These estimates translate to prevention of 7·8% (5·6–11·0) of all AMR-associated mortality in LMICs by infection prevention and control, 5·7% (3·7–8·0) by water, sanitation, and hygiene, and 4·2% (3·4–5·1) by vaccination interventions. Despite the continuing need for research and innovation to overcome limitations of existing approaches, our findings indicate that reducing global AMR burden by 10% by the year 2030 is achievable with existing interventions. Our results should guide investments in public health interventions with the greatest potential to reduce AMR burden.

中文翻译：

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低收入和中等收入国家的细菌耐药性负担可通过现有干预措施避免：证据审查和模型分析


国家行动计划列举了许多干预措施作为减轻细菌抗菌素耐药性 (AMR) 负担的潜在策略。然而，需要了解具体方法可实现的益处，以便为政策制定提供信息，特别是在抗微生物药物耐药性负担沉重且医疗保健系统能力较低的低收入和中等收入国家 (LMIC)。在模型分析中，我们估计，改善中低收入国家卫生保健机构的感染预防和控制计划每年可以预防至少 337 000 (95% CI 250 200–465 200) 例 AMR 相关死亡。确保普遍获得高质量的水、环境卫生和个人卫生服务将通过直接预防预防 247 800 (160 000–337 800) 例 AMR 相关死亡和儿科疫苗 181 500 (153 400–206 800) 例 AMR 相关死亡抗药性感染和抗生素消耗的减少。这些估计意味着中低收入国家通过感染预防和控制可预防 7·8% (5·6–11·0) 的所有 AMR 相关死亡率，通过水、卫生设施可预防 5·7% (3·7–8·0)和卫生，以及 4·2% (3·4–5·1) 通过疫苗接种干预措施。尽管仍然需要研究和创新来克服现有方法的局限性，但我们的研究结果表明，通过现有干预措施，到 2030 年将全球 AMR 负担减少 10% 是可以实现的。我们的结果应该指导对最有可能减少抗菌素耐药性负担的公共卫生干预措施的投资。