A recent modeling study has revealed that only 6.9% of carbapenem-resistant Gram-negative (CRGN) bacterial infections received appropriate treatment in 2019 across eight low- and middle-income countries (LMICs). These countries Bangladesh, Brazil, Egypt, India, Kenya, Mexico, Pakistan, and South Africa collectively experienced around 1.5 million CRGN infections, yet only approximately 103,000 courses of effective antibiotics were procured. This translates to an estimated 1.39 million infections going untreated.
India accounted for the vast majority 80.5% of the effective antibiotic procurement, while countries like Mexico and Egypt had the highest rates of treatment coverage at just 14.9%. Intravenous tigecycline emerged as the most commonly procured antibiotic, representing nearly half of all treatments administered across the studied nations.
CRGN pathogens were the focus of the analysis due to their extreme drug resistance and the scarcity of effective treatment options. These pathogens are recognized globally as critical threats because of their high mortality risk and limited therapeutic avenues. The researchers used data from global disease burden estimates, pharmaceutical sales figures, and published mortality rates to model the treatment gap. They first estimated the total number of deaths from CRGN infections and then extrapolated the number of infections using case fatality rates. From this, they subtracted the number of treated cases adjusted for medication coverage and dosage patterns to determine the magnitude of undertreatment.
The findings consistently indicated a significant treatment gap across various modeling approaches, emphasizing the robustness of the result even when using conservative estimates. However, the study also acknowledged the limitations inherent in relying on pharmaceutical sales data, especially in LMICs where data availability and reliability can be inconsistent.
One of the most pressing concerns highlighted by the research is the lack of clarity about where in the healthcare system the treatment pathway breaks down. The data used did not reveal the specific bottlenecks that prevent patients from receiving appropriate care. It is suspected that both limited access to diagnostic tools and a lack of availability of effective antibiotics are major contributing factors. However, the precise extent to which each factor contributes remains unclear, particularly in settings where large populations may not even access the formal healthcare system.
To better understand and address these systemic failures, the researchers proposed adopting care cascade models, which have proven effective in HIV treatment programs. These models follow the patient journey from diagnosis through treatment initiation to successful completion, allowing stakeholders to identify where drop-offs occur and target interventions accordingly.
There is also a call for enhanced data collection and the involvement of local experts to refine estimates and gain more accurate insights into treatment gaps. While better data is crucial, the urgency of the situation calls for immediate action. Many patients are currently not receiving the care they need, and waiting for perfect information could cost lives. National programs that are already working to improve diagnosis and treatment should be supported with greater political backing and resources.
Additionally, setting care cascade targets could be a valuable strategy for holding health systems accountable and tracking progress in treating drug-resistant infections. Such frameworks could guide both national and international efforts to close the alarming treatment gap and improve outcomes for patients facing these life-threatening infections.
