 Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050Mohsen Naghavi, Stein Emil Vollset, Kevin S Ikuta, Lucien R Swetschinski, Authia P Gray, Eve E Wool, Gisela Robles Aguilar, Tomislav Mestrovic, Georgia Smith, Chieh Han, Rebecca L Hsu, Ahmed Y. Azzam, Mahsa Babaei, Francois-Xavier Babin, Muhammad Badar, Atif Amin Baig, Milica Bajcetic, Stephen Baker, Mainak Bardhan, Hiba Jawdat Barqawi, Zarrin Basharat, Julian Chalek, Afisu Basiru, Mathieu Bastard, Saurav Basu, Nebiyou Simegnew Bayleyegn, Melaku Ashagrie Belete, Olorunjuwon Omolaja Bello, Apostolos Beloukas, James A Berkley, Akshaya Srikanth Bhagavathula, Sonu Bhaskar, Daniel T Araki, Soumitra S Bhuyan, Julia A Bielicki, Nikolay Ivanovich Briko, Colin Stewart Brown, Annie J Browne, Danilo Buonsenso, Yasser Bustanji, Cristina G Carvalheiro, Carlos A Castañeda-Orjuela, Muthia Cenderadewi, Erin Chung, Joshua Chadwick, Sandip Chakraborty, Rama Mohan Chandika, Sara Chandy, Vilada Chansamouth, Vijay Kumar Chattu, Anis Ahmad Chaudhary, Patrick R Ching, Hitesh Chopra, Fazle Rabbi Chowdhury, Catalina Raggi, Dinh-Toi Chu, Muhammad Chutiyami, Natalia Cruz-Martins, Alanna Gomes da Silva, Omid Dadras, Xiaochen Dai, Samuel D Darcho, Saswati Das, Fernando Pio De la Hoz, Denise Myriam Dekker, Anna Gershberg Hayoon, Kuldeep Dhama, Daniel Diaz, Benjamin Felix Rothschild Dickson, Serge Ghislain Djorie, Milad Dodangeh, Sushil Dohare, Klara Georgieva Dokova, Ojas Prakashbhai Doshi, Robert Kokou Dowou, Haneil Larson Dsouza, Nicole Davis Weaver, Susanna J Dunachie, Arkadiusz Marian Dziedzic, Tim Eckmanns, Abdelaziz Ed-Dra, Aziz Eftekharimehrabad, Temitope Cyrus Ekundayo, Iman El Sayed, Muhammed Elhadi, Waseem El-Huneidi, Christelle Elias, Paulina A Lindstedt, Sally J Ellis, Randa Elsheikh, Ibrahim Elsohaby, Chadi Eltaha, Babak Eshrati, Majid Eslami, David William Eyre, Adewale Oluwaseun Fadaka, Adeniyi Francis Fagbamigbe, Ayesha Fahim, Amanda E Smith, Aliasghar Fakhri-Demeshghieh, Folorunso Oludayo Fasina, Modupe Margaret Fasina, Ali Fatehizadeh, Nicholas A Feasey, Alireza Feizkhah, Ginenus Fekadu, Florian Fischer, Ida Fitriana, Karen M Forrest, Umut Altay, Celia Fortuna Rodrigues, John E Fuller, Muktar A Gadanya, Márió Gajdács, Aravind P Gandhi, Esteban E Garcia-Gallo, Denise O Garrett, Rupesh K Gautam, Miglas Welay Gebregergis, Mesfin Gebrehiwot, Natalia V Bhattacharjee, Teferi Gebru Gebremeskel, Christine Geffers, Leonidas Georgalis, Ramy Mohamed Ghazy, Mahaveer Golechha, Davide Golinelli, Melita Gordon, Snigdha Gulati, Rajat Das Gupta, Sapna Gupta, Konstantinos Giannakis, Vijai Kumar Gupta, Awoke Derbie Habteyohannes, Sebastian Haller, Harapan Harapan, Michelle L Harrison, Ahmed I Hasaballah, Ikramul Hasan, Rumina Syeda Hasan, Hamidreza Hasani, Andrea Haekyung Haselbeck, Frederick Fell, Md Saquib Hasnain, Ikrama Ibrahim Hassan, Shoaib Hassan, Mahgol Sadat Hassan Zadeh Tabatabaei, Khezar Hayat, Jiawei He, Omar E Hegazi, Mohammad Heidari, Kamal Hezam, Ramesh Holla, Barney McManigal, Marianne Holm, Heidi Hopkins, Md Mahbub Hossain, Mehdi Hosseinzadeh, Sorin Hostiuc, Nawfal R Hussein, Le Duc Huy, Elsa D Ibáñez-Prada, Adalia Ikiroma, Irena M Ilic, Nattwut Ekapirat, Sheikh Mohammed Shariful Islam, Faisal Ismail, Nahlah Elkudssiah Ismail, Chidozie Declan Iwu, Chinwe Juliana Iwu-Jaja, Abdollah Jafarzadeh, Fatoumatta Jaiteh, Reza Jalilzadeh Yengejeh, Roland Dominic G Jamora, Javad Javidnia, Jessica Andretta Mendes, Talha Jawaid, Adam W J Jenney, Hyon Jin Jeon, Mohammad Jokar, Nabi Jomehzadeh, Tamas Joo, Nitin Joseph, Zul Kamal, Kehinde Kazeem Kanmodi, Rami S Kantar, Tilleye Runghien, James Apollo Kapisi, Ibraheem M Karaye, Yousef Saleh Khader, Himanshu Khajuria, Nauman Khalid, Faham Khamesipour, Ajmal Khan, Mohammad Jobair Khan, Muhammad Tariq Khan, Vishnu Khanal, Oraya Srimokla, Feriha Fatima Khidri, Jagdish Khubchandani, Suwimon Khusuwan, Min Seo Kim, Adnan Kisa, Vladimir Andreevich Korshunov, Fiorella Krapp, Ralf Krumkamp, Mohammed Kuddus, Mukhtar Kulimbet, Atef Abdelkader, Dewesh Kumar, Emmanuelle A P Kumaran, Ambily Kuttikkattu, Hmwe Hmwe Kyu, Iván Landires, Basira Kankia Lawal, Thao Thi Thu Le, Ingeborg Maria Lederer, Munjae Lee, Seung Won Lee, Sherief Abd-Elsalam, Alain Lepape, Temesgen Leka Lerango, Virendra S Ligade, Cherry Lim, Stephen S Lim, Liknaw Workie Limenh, Chaojie Liu, Xiaofeng Liu, Xuefeng Liu, Michael J Loftus, Richard Gyan Aboagye, Hawraz Ibrahim M Amin, Kelsey Lynn Maass, Sandeep B Maharaj, Mansour Adam Mahmoud, Panagiota Maikanti-Charalampous, Omar M Makram, Kashish Malhotra, Ahmad Azam Malik, Georgia D Mandilara, Florian Marks, Hassan Abolhassani, Bernardo Alfonso Martinez-Guerra, Miquel Martorell, Hossein Masoumi-Asl, Alexander G Mathioudakis, Juergen May, Theresa A McHugh, James Meiring, Hadush Negash Meles, Addisu Melese, Endalkachew Belayneh Melese, Hasan Abualruz, Giuseppe Minervini, Nouh Saad Mohamed, Shafiu Mohammed, Syam Mohan, Ali H Mokdad, Lorenzo Monasta, AmirAli Moodi Ghalibaf, Catrin E Moore, Yousef Moradi, Elias Mossialos, Usman Abubakar, Vincent Mougin, George Duke Mukoro, Francesk Mulita, Berit Muller-Pebody, Efren Murillo-Zamora, Sani Musa, Patrick Musicha, Lillian A Musila, Saravanan Muthupandian, Ahamarshan Jayaraman Nagarajan, Hana J Abukhadijah, Pirouz Naghavi, Firzan Nainu, Tapas Sadasivan Nair, Hastyar Hama Rashid Najmuldeen, Zuhair S Natto, Javaid Nauman, Biswa Prakash Nayak, G Takop Nchanji, Pacifique Ndishimye, Ionut Negoi, Salahdein Aburuz, Ruxandra Irina Negoi, Seyed Aria Nejadghaderi, QuynhAnh P Nguyen, Efaq Ali Noman, Davis C Nwakanma, Seamus O'Brien, Theresa J Ochoa, Ismail A Odetokun, Oluwaseun Adeolu Ogundijo, Tolulope R Ojo-Akosile, Ahmed Abu-Zaid, Sylvester Reuben Okeke, Osaretin Christabel Okonji, Andrew T Olagunju, Antonio Olivas-Martinez, Abdulhakeem Abayomi Olorukooba, Peter Olwoch, Kenneth Ikenna Onyedibe, Edgar Ortiz-Brizuela, Olayinka Osuolale, Pradthana Ounchanum, Sureerak Achalapong, Oyetunde T Oyeyemi, Mahesh Padukudru P A, Jose L Paredes, Romil R Parikh, Jay Patel, Shankargouda Patil, Shrikant Pawar, Anton Y Peleg, Prince Peprah, João Perdigão, Isaac Yeboah Addo, Carlo Perrone, Ionela-Roxana Petcu, Koukeo Phommasone, Zahra Zahid Piracha, Dimitri Poddighe, Andrew J Pollard, Ramesh Poluru, Alfredo Ponce-De-Leon, Jagadeesh Puvvula, Farah Naz Qamar, Victor Adekanmbi, Nameer Hashim Qasim, Clotaire Donatien Rafai, Pankaja Raghav, Leila Rahbarnia, Fakher Rahim, Vafa Rahimi-Movaghar, Mosiur Rahman, Muhammad Aziz Rahman, Hazem Ramadan, Shakthi Kumaran Ramasamy, Temitayo Esther Adeyeoluwa, Pushkal Sinduvadi Ramesh, Pramod W Ramteke, Rishabh Kumar Rana, Usha Rani, Mohammad-Mahdi Rashidi, Devarajan Rathish, Sayaphet Rattanavong, Salman Rawaf, Elrashdy Moustafa Mohamed Redwan, Luis Felipe Reyes, Qorinah Estiningtyas Sakilah Adnani, Tamalee Roberts, Julie V Robotham, Victor Daniel Rosenthal, Allen Guy Ross, Nitai Roy, Kristina E Rudd, Cameron John Sabet, Basema Ahmad Saddik, Mohammad Reza Saeb, Umar Saeed, Leticia Akua Adzigbli, Sahar Saeedi Moghaddam, Weeravoot Saengchan, Mohsen Safaei, Amene Saghazadeh, Narjes Saheb Sharif-Askari, Amirhossein Sahebkar, Soumya Swaroop Sahoo, Maitreyi Sahu, Morteza Saki, Nasir Salam, Muhammad Sohail Afzal, Zikria Saleem, Mohamed A Saleh, Yoseph Leonardo Samodra, Abdallah M Samy, Aswini Saravanan, Maheswar Satpathy, Austin E Schumacher, Mansour Sedighi, Samroeng Seekaew, Mahan Shafie, Saira Afzal, Pritik A Shah, Samiah Shahid, Moyad Jamal Shahwan, Sadia Shakoor, Noga Shalev, Muhammad Aaqib Shamim, Mohammad Ali Shamshirgaran, Anas Shamsi, Amin Sharifan, Rajesh P Shastry, Antonella Agodi, Mahabalesh Shetty, Aminu Shittu, Sunil Shrestha, Emmanuel Edwar Siddig, Theologia Sideroglou, Jose Sifuentes-Osornio, Luís Manuel Lopes Rodrigues Silva, Eric A F Simões, Andrew J H Simpson, Amit Singh, Austin J Ahlstrom, Surjit Singh, Robert Sinto, Sameh S M Soliman, Soroush Soraneh, Nicole Stoesser, Temenuga Zhekova Stoeva, Chandan Kumar Swain, Lukasz Szarpak, Sree Sudha T Y, Shima Tabatabai, Aqeel Ahmad, Celine Tabche, Zanan Mohammed-Ameen Taha, Ker-Kan Tan, Nidanuch Tasak, Nathan Y Tat, Areerat Thaiprakong, Pugazhenthan Thangaraju, Caroline Chepngeno Tigoi, Krishna Tiwari, Marcos Roberto Tovani-Palone, Sajjad Ahmad, Thang Huu Tran, Munkhtuya Tumurkhuu, Paul Turner, Aniefiok John Udoakang, Arit Udoh, Noor Ullah, Saeed Ullah, Asokan Govindaraj Vaithinathan, Mario Valenti, Theo Vos, Tauseef Ahmad, Huong T L Vu, Yasir Waheed, Ann Sarah Walker, Judd L Walson, Tri Wangrangsimakul, Kosala Gayan Weerakoon, Heiman F L Wertheim, Phoebe C M Williams, Asrat Arja Wolde, Teresa M Wozniak, Ali Ahmadi, Felicia Wu, Zenghong Wu, Mukesh Kumar Kumar Yadav, Sajad Yaghoubi, Zwanden Sule Yahaya, Amir Yarahmadi, Saber Yezli, Yazachew Engida Yismaw, Dong Keon Yon, Chun-Wei Yuan, Ayman Ahmed, Hadiza Yusuf, Fathiah Zakham, Giulia Zamagni, Haijun Zhang, Zhi-Jiang Zhang, Magdalena Zielińska, Alimuddin Zumla, Sa'ed H. H Zyoud, Samer H Zyoud, Simon I Hay, Haroon Ahmed, Andy Stergachis, Benn Sartorius, Ben S Cooper, Christiane Dolecek, Christopher J L Murray, Ibrar Ahmed, Mohammed Ahmed, Saeed Ahmed, Syed Anees Ahmed, Mohammed Ahmed Akkaif, Salah Al Awaidy, Yazan Al Thaher, Samer O Alalalmeh, Mohammad T AlBataineh, Wafa A Aldhaleei, Adel Ali Saeed Al-Gheethi, Nma Bida Alhaji, Abid Ali, Liaqat Ali, Syed Shujait Ali, Waad Ali, Kasim Allel, Sabah Al-Marwani, Ahmad Alrawashdeh, Awais Altaf, Alaa B. Al-Tammemi, Jaffar A Al-Tawfiq, Karem H Alzoubi, Walid Adnan Al-Zyoud, Ben Amos, John H Amuasi, Robert Ancuceanu, Jason R Andrews, Abhishek Anil, Iyadunni Adesola Anuoluwa, Saeid Anvari, Anayochukwu Edward Anyasodor, Geminn Louis Carace Apostol, Jalal Arabloo, Mosab Arafat, Aleksandr Y Aravkin, Demelash Areda, Abdulfatai Aremu, Anton A Artamonov, Elizabeth A Ashley, Marvellous O Asika, Seyyed Shamsadin Athari, Maha Moh'd Wahbi Atout, Tewachew Awoke, Sina Azadnajafabad, James Mba Azam and Shahkaar Aziz Open Access Publications from Kiel Institute for the World Economy from Kiel Institute for the World Economy (IfW Kiel) Abstract: Background: Antimicrobial (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 261000 associated deaths [95% UI 150000–372 000] and 57200 attributable deaths [34100–80 300] in 1990, to 550 000 associated deaths [500000–600000] and 130000 attributable deaths [113000–146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619000 associated deaths (405 000–834000) in 1990, to 1·03 million associated deaths (909000–1·16 million) in 2021, and from 127 000 attributable deaths (82 100–171000) in 1990, to 216 000 (168 000–264000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56–2·26) deaths attributable to AMR and 8·22 million (6·85–9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2–69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5–89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (–6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8–102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram negative drug scenario, 11·1 million AMR deaths (9·08–13·2) could be averted through the development of a Gram negative drug pipeline to prevent AMR deaths. Interpretation: This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary Lancet 2024; 404: 1199–226 Published Online September 16, 2024 https://doi.org/10.1016/ S0140-6736(24)01867-1 See Comment page 1172 *Collaborators listed at the end of the Article Correspondence to: Christopher J L Murray, Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, University of Washington School of Medicine, Seattle, WA 98195, USA cjlm@uw.edu Articles 1200 www.thelancet.com Vol 404 September 28, 2024 to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050. Date: 2024 Downloads: (external link) Related works: Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text Persistent link: https://EconPapers.repec.org/RePEc:zbw:ifwkie:306603 DOI: 10.1016/S0140-6736(24)01867-1 Access Statistics for this paper More papers in Open Access Publications from Kiel Institute for the World Economy from Kiel Institute for the World Economy (IfW Kiel) Contact information at EDIRC. |
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