Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050
Articolo
Data di Pubblicazione:
2024
Abstract:
Background: Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts. Methods: We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen–drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level. Findings: In 2021, we estimated 4·71 million (95% UI 4·23–5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00–1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000–372 000] and 57 200 attributable deaths [34 100–80 300] in 1990, to 550 000 associated deaths [500 000–600 000] and 130 000 attributable deaths [113 000–146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000–834 000) in 1990, to 1·03 million associated deaths (909 000–1·16 million) in 2021, and from 127 000 attributable deaths (82 100–171 000
Tipologia CRIS:
1.1 Articolo in rivista
Elenco autori:
Naghavi, M.; Vollset, S. E.; Ikuta, K. S.; Swetschinski, L. R.; Gray, A. P.; Wool, E. E.; Robles Aguilar, G.; Mestrovic, T.; Smith, G.; Han, C.; Hsu, R. L.; Chalek, J.; Araki, D. T.; Chung, E.; Raggi, C.; Gershberg Hayoon, A.; Davis Weaver, N.; Lindstedt, P. A.; Smith, A. E.; Altay, U.; Bhattacharjee, N. V.; Giannakis, K.; Fell, F.; Mcmanigal, B.; Ekapirat, N.; Mendes, J. A.; Runghien, T.; Srimokla, O.; Abdelkader, A.; Abd-Elsalam, S.; Aboagye, R. G.; Abolhassani, H.; Abualruz, H.; Abubakar, U.; Abukhadijah, H. J.; Aburuz, S.; Abu-Zaid, A.; Achalapong, S.; Addo, I. Y.; Adekanmbi, V.; Adeyeoluwa, T. E.; Adnani, Q. E. S.; Adzigbli, L. A.; Afzal, M. S.; Afzal, S.; Agodi, A.; Ahlstrom, A. J.; Ahmad, A.; Ahmad, S.; Ahmad, T.; Ahmadi, A.; Ahmed, A.; Ahmed, H.; Ahmed, I.; Ahmed, M.; Ahmed, S.; Ahmed, S. A.; Akkaif, M. A.; Al Awaidy, S.; Al Thaher, Y.; Alalalmeh, S. O.; Albataineh, M. T.; Aldhaleei, W. A.; Al-Gheethi, A. A. S.; Alhaji, N. B.; Ali, A.; Ali, L.; Ali, S. S.; Ali, W.; Allel, K.; Al-Marwani, S.; Alrawashdeh, A.; Altaf, A.; Al-Tammemi, A. B.; Al-Tawfiq, J. A.; Alzoubi, K. H.; Al-Zyoud, W. A.; Amos, B.; Amuasi, J. H.; Ancuceanu, R.; Andrews, J. R.; Anil, A.; Anuoluwa, I. A.; Anvari, S.; Anyasodor, A. E.; Apostol, G. L. C.; Arabloo, J.; Arafat, M.; Aravkin, A. Y.; Areda, D.; Aremu, A.; Artamonov, A. A.; Ashley, E. A.; Asika, M. O.; Athari, S. S.; Atout, M. M. W.; Awoke, T.; Azadnajafabad, S.; Azam, J. M.; Aziz, S.; Azzam, A. Y.; Babaei, M.; Babin, F. -X.; Badar, M.; Baig, A. A.; Bajcetic, M.; Baker, S.; Bardhan, M.; Barqawi, H. J.; Basharat, Z.; Basiru, A.; Bastard, M.; Basu, S.; Bayleyegn, N. S.; Belete, M. A.; Bello, O. O.; Beloukas, A.; Berkley, J. A.; Bhagavathula, A. S.; Bhaskar, S.; Bhuyan, S. S.; Bielicki, J. A.; Briko, N. I.; Brown, C. S.; Browne, A. J.; Buonsenso, D.; Bustanji, Y.; Carvalheiro, C. G.; Castaneda-Orjuela, C. A.; Cenderadewi, M.; Chadwick, J.; Chakraborty, S.; Chandika, R. M.; Chandy, S.; Chansamouth, V.; Chattu, V. K.; Chaudhary, A. A.; Ching, P. R.; Chopra, H.; Chowdhury, F. R.; Chu, D. -T.; Chutiyami, M.; Cruz-Martins, N.; Da Silva, A. G.; Dadras, O.; Dai, X.; Darcho, S. D.; Das, S.; De La Hoz, F. P.; Dekker, D. M.; Dhama, K.; Diaz, D.; Dickson, B. F. R.; Djorie, S. G.; Dodangeh, M.; Dohare, S.; Dokova, K. G.; Doshi, O. P.; Dowou, R. K.; Dsouza, H. L.; Dunachie, S. J.; Dziedzic, A. M.; Eckmanns, T.; Ed-Dra, A.; Eftekharimehrabad, A.; Ekundayo, T. C.; El Sayed, I.; Elhadi, M.; El-Huneidi, W.; Elias, C.; Ellis, S. J.; Elsheikh, R.; Elsohaby, I.; Eltaha, C.; Eshrati, B.; Eslami, M.; Eyre, D. W.; Fadaka, A. O.; Fagbamigbe, A. F.; Fahim, A.; Fakhri-Demeshghieh, A.; Fasina, F. O.; Fasina, M. M.; Fatehizadeh, A.; Feasey, N. A.; Feizkhah, A.; Fekadu, G.; Fischer, F.; Fitriana, I.; Forrest, K. M.; Fortuna Rodrigues, C.; Fuller, J. E.; Gadanya, M. A.; Gajdacs, M.; Gandhi, A. P.; Garcia-Gallo, E. E.; Garrett, D. O.; Gautam, R. K.; Gebregergis, M. W.; Gebrehiwot, M.; Gebremeskel, T. G.; Geffers, C.; Georgalis, L.; Ghazy, R. M.; Golechha, M.; Golinelli, D.; Gordon, M.; Gulati, S.; Gupta, R. D.; Gupta, S.; Gupta, V. K.; Habteyohannes, A. D.; Haller, S.; Harapan, H.; Harrison, M. L.; Hasaballah, A. I.; Hasan, I.; Hasan, R. S.; Hasani, H.; Haselbeck, A. H.; Hasnain, M. S.; Hassan, I. I.; Hassan, S.; Hassan Zadeh Tabatabaei, M. S.; Hayat, K.; He, J.; Hegazi, O. E.; Heidari, M.; Hezam, K.; Holla, R.; Holm, M.; Hopkins, H.; Hossain, M. M.; Hosseinzadeh, M.; Hostiuc, S.; Hussein, N. R.; Huy, L. D.; Ibanez-Prada, E. D.; Ikiroma, A.; Ilic, I. M.; Islam, S. M. S.; Ismail, F.; Ismail, N. E.; Iwu, C. D.; Iwu-Jaja, C. J.; Jafarzadeh, A.; Jaiteh, F.; Jalilzadeh Yengejeh, R.; Jamora, R. D. G.; Javidnia, J.; Jawaid, T.; Jenney, A. W. J.; Jeon, H. J.; Jokar, M.; Jomehzadeh, N.; Joo, T.; Joseph, N.; Kamal, Z.; Kanmodi, K. K.; Kantar, R. S.; Kapisi, J. A.; Karaye, I. M.; Khader, Y. S.; Khajuria, H.; Khalid, N.; Khamesipour, F.; Khan, A.; Khan, M. J.; Khan, M. T.; Khanal, V.; Khidri, F. F.; Khubchandani, J.; Khusuwan, S.; Kim, M. S.
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