A MAJOR treatment gap for life-threatening carbapenem-resistant Gram-negative (CRGN) bacterial infections has been revealed across eight low- and middle-income countries (LMICs), with only a fraction of patients estimated to receive appropriate therapy.
Researchers assessed the burden of CRGN bacterial infections and treatment coverage in Bangladesh, Brazil, Egypt, India, Kenya, Mexico, Pakistan, and South Africa using 2019 data. Deaths associated with CRGN infections, sourced from the Global Burden of Disease 2021 study on antimicrobial resistance, were used alongside published case fatality rates to estimate total infections requiring effective treatment. These were compared against estimated antibiotic procurement figures from IQVIA sales data for six relevant drugs, adjusted for partial market coverage and age-specific dosing.
The analysis estimated 1,496,219 CRGN bacterial infections across the eight countries in 2019 (95% CI 1,365,392–1,627,047), yet only 103,647 courses of effective antibiotics were procured, covering just 6.9% of cases. This left an estimated treatment gap of 1,392,572 infections (95% CI 1,261,745–1,523,400). India accounted for the majority of treatment courses (83,468, or 80.5%), but with only 7.8% of patients likely treated appropriately. Mexico and Egypt had the highest estimated treatment coverage at 14.9%, yet the absolute numbers remained low: only 5,634 and 7,572 treatment courses respectively. Tigecycline was the most procured antibiotic, comprising 45.9% of all courses. These figures held true even under more conservative assumptions, highlighting a widespread failure to deliver adequate treatment for a growing antimicrobial resistance threat.
The findings reinforce the urgent need to close the CRGN treatment gap in LMICs. Strengthened diagnostic capacity, improved antibiotic availability, and system-wide investment in healthcare infrastructure are essential to address this critical public health crisis.
Reference
Mishra A et al. Estimated undertreatment of carbapenem-resistant Gram-negative bacterial infections in eight low-income and middle-income countries: a modelling study. Lancet Infect Dis. 2025; DOI:10.1016/S1473-3099(25)00108-2.
