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Christopher J L Murray, Kevin Shunji Ikuta, Fablina Sharara, Lucien R Swetschinski, Gisela Robles Aguilar, Authia P Gray, Chieh Han, Catherine Bisignano, Puja C Rao, Eve E Wool and 165 more
BACKGROUND: Antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen-drug combinations in select locations. To our knowledge, this study presents the most comprehensive estimates of AMR burden to date. METHODS: We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019. We obtained data from systematic literature reviews, hospital systems, surveillance systems, and other sources, covering 471 million individual records or isolates and 7585 study-location-years. We used predictive statistical modelling to produce estimates of AMR burden for all locations, including for locations with no data. Our approach can be divided into five broad components: number of deaths where infection played a role, proportion of infectious deaths attributable to a given infectious syndrome, 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 based on two counterfactuals: deaths attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and deaths associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. We present final estimates aggregated to the global and regional level. FINDINGS: On the basis of our predictive statistical models, there were an estimated 4·95 million (3·62-6·57) deaths associated with bacterial AMR in 2019, including 1·27 million (95% UI 0·911-1·71) deaths attributable to bacterial AMR. At the regional level, we estimated the all-age death rate attributable to resistance to be highest in western sub-Saharan Africa, at 27·3 deaths per 100 000 (20·9-35·3), and lowest in Australasia, at 6·5 deaths (4·3-9·4) per 100 000. Lower respiratory infections accounted for more than 1·5 million deaths associated with resistance in 2019, making it the most burdensome infectious syndrome. The six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for 929 000 (660 000-1 270 000) deaths attributable to AMR and 3·57 million (2·62-4·78) deaths associated with AMR in 2019. One pathogen-drug combination, meticillin-resistant S aureus, caused more than 100 000 deaths attributable to AMR in 2019, while six more each caused 50 000-100 000 deaths: multidrug-resistant excluding extensively drug-resistant tuberculosis, third-generation cephalosporin-resistant E coli, carbapenem-resistant A baumannii, fluoroquinolone-resistant E coli, carbapenem-resistant K pneumoniae, and third-generation cephalosporin-resistant K pneumoniae. INTERPRETATION: To our knowledge, this study provides the first comprehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data. AMR is a leading cause of death around the world, with the highest burdens in low-resource settings. Understanding the burden of AMR and the leading pathogen-drug combinations contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics. There are serious data gaps in many low-income settings, emphasising the need to expand microbiology laboratory capacity and data collection systems to improve our understanding of this important human health threat. FUNDING: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.
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Murray, C. J. L., Ikuta, K. S., Sharara, F., Swetschinski, L. R., Aguilar, G. R., Gray, A. P., Han, C., Bisignano, C., Rao, P. C., Wool, E. E., Johnson, S. C., Browne, A. J., Chipeta, M. G., Fell, F., Hackett, S. C., Haines–Woodhouse, G., Hamadani, B. H. K., Kumaran, E. A. P., McManigal, B., … Naghavi, M. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, 399(10325), 629–655. https://doi.org/10.1016/s0140-6736(21)02724-0
Murray, Christopher J L, et al. "Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis." The Lancet, vol. 399, no. 10325, 2022, pp. 629–655, https://doi.org/10.1016/s0140-6736(21)02724-0.
Murray, Christopher J L, Kevin Shunji Ikuta, Fablina Sharara, Lucien R Swetschinski, Gisela Robles Aguilar, Authia P Gray, Chieh Han, et al. "Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis." The Lancet 399, no. 10325 (2022): 629–655. https://doi.org/10.1016/s0140-6736(21)02724-0.
Murray C. J. L., Ikuta K. S., Sharara F. [и др.] Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis // The Lancet. — 2022. — Vol. 399, № 10325. — P. 629–655. — URL: https://doi.org/10.1016/s0140-6736(21)02724-0
@article{murray2022global,
title = {{Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis}},
author = {Christopher J L Murray and Kevin Shunji Ikuta and Fablina Sharara and Lucien R Swetschinski and Gisela Robles Aguilar and Authia P Gray and Chieh Han and Catherine Bisignano and Puja C Rao and Eve E Wool and Sarah Charlotte Johnson and Annie J. Browne and Michael Give Chipeta and Frederick Fell and Sean C. Hackett and Georgina Haines–Woodhouse and Bahar H. Kashef Hamadani and Emmanuelle A. P. Kumaran and Barney McManigal and Sureeruk Achalapong and Ramesh K. Agarwal and Samuel Akech and Samuel B Albertson and John Amuasi and Jason Randolph Andrews and Aleskandr Aravkin and Elizabeth A. Ashley and François-Xavier Babin and Freddie Bailey and Stephen G. Baker and Buddha Basnyat and Adrie Bekker and Rose Grace Bender and James Alexander Berkley and Bethou Adhisivam and Julia Anna Bielicki and Suppawat Boonkasidecha and James Bukosia and Cristina Gardonyi Carvalheiro and Carlos Andrés Castañeda-Orjuela and Vilada Chansamouth and Suman Chaurasia and Sara Chiurchiù and Fazle Rabbi Chowdhury and Rafai Clotaire Donatien and Aislinn Cook and Ben Symons Cooper and Tim Roy Cressey and Elia Criollo-Mora and Matthew W. Cunningham and Saffiatou Darboe and Nicholas Day and Maia De Luca and Klara Georgieva Dokova and Angela Dramowski and Susanna Jane Dunachie and Duong Bich Thuy and Tim Eckmanns and Daniel Eibach and Amir Emami and Nicholas Feasey and Natasha Fisher-Pearson and Karen Forrest and Coralith Garcia and Denise Oliveira Garrett and Petra Gastmeier and Ababi Zergaw Giref and Rachel Claire Greer and Vikas Gupta and Sebastian Haller and Andrea Haselbeck and Simon Iain Hay and Marianne Holm and Susan Hopkins and Yingfen Hsia and Kenneth Chukwuemeka Iregbu and Jan Adriaan Jacobs and Daniel Jarovsky and Fatemeh Javanmardi and Adam W. J. Jenney and Meera Khorana and Suwimon Khusuwan and Niranjan “Tex” Kissoon and Elsa Kobeissi and Tomislav Kostyanev and Fiorella Krapp and Ralf Krumkamp and Ajay M. V. Kumar and Hmwe Hmwe Kyu and Cherry Lim and Kruy Lim and Direk Limmathurotsakul and Michael J. Loftus and Miles Lunn and Jianing Ma and Anand Manoharan and Florian Marks and Jürgen May and Mayfong Mayxay and Neema Mturi and Tatiana Múnera‐Huertas and Patrick Musicha and Lilian A Musila and Marisa Márcia Mussi‐Pinhata and Ravi Narayan Naidu and Tomoka Nakamura and Ruchi Nimish Nanavati and Sushma Nangia and Paul N. Newton and Chanpheaktra Ngoun and Amanda Novotney and Davis C. Nwakanma and Christina W. Obiero and Theresa Jean Ochoa and Antonio Olivas‐Martínez and Piero Olliaro and Edna Ooko and Edgar Ortíz‐Brizuela and Pradthana Ounchanum and Gi Deok Pak and José Luis Paredes and Anton Yariv Peleg and Carlo Perrone and Thong Phe and Koukeo Phommasone and Nishad Plakkal and Alfredo Ponce‐de‐León and Mathieu Raad and Tanusha Ramdin and Sayaphet Rattanavong and Amy Riddell and Tamalee Roberts and Julie V. Robotham and Anna Roca and Víctor Rosenthal and Kristina E. Rudd and Neal Russell and Helio Silva Sader and Weerawut Saengchan and Jesse Schnall and John A. Scott and Samroeng Seekaew and Mike Sharland and Madhusudhan Shivamallappa and José Sifuentes‐Osornio and Andrew J. H. Simpson and Nicolas Steenkeste and Andrew James Stewardson and Temenuga Zhekova Stoeva and Nidanuch Tasak and Areerat Thaiprakong and Guy Edward Thwaites and Caroline Tigoi and Claudia L. Turner and Paul Turner and H. Rogier van Doorn and Sithembiso Velaphi and Avina Vongpradith and Manivanh Vongsouvath and Huong T L Vu and Timothy Walsh and Judd L. Walson and Seymour Waner and Tri Wangrangsimakul and Prapass Wannapinij and Teresa Maria Wozniak and Tracey E M W Young Sharma and Kalvin C. Yu and Peng Zheng and Benn K. D. Sartorius and Alan D López and Andy S. Stergachis and Catrin E. Moore and Christiane Dolecek and Mohsen Naghavi},
journal = {The Lancet},
year = {2022},
volume = {399},
number = {10325},
pages = {629--655},
doi = {10.1016/s0140-6736(21)02724-0},
url = {https://doi.org/10.1016/s0140-6736(21)02724-0}
}TY - JOUR AU - Murray, Christopher J L AU - Ikuta, Kevin Shunji AU - Sharara, Fablina AU - Swetschinski, Lucien R AU - Aguilar, Gisela Robles AU - Gray, Authia P AU - Han, Chieh AU - Bisignano, Catherine AU - Rao, Puja C AU - Wool, Eve E AU - Johnson, Sarah Charlotte AU - Browne, Annie J. AU - Chipeta, Michael Give AU - Fell, Frederick AU - Hackett, Sean C. AU - Haines–Woodhouse, Georgina AU - Hamadani, Bahar H. Kashef AU - Kumaran, Emmanuelle A. P. AU - McManigal, Barney AU - Achalapong, Sureeruk AU - Agarwal, Ramesh K. AU - Akech, Samuel AU - Albertson, Samuel B AU - Amuasi, John AU - Andrews, Jason Randolph AU - Aravkin, Aleskandr AU - Ashley, Elizabeth A. AU - Babin, François-Xavier AU - Bailey, Freddie AU - Baker, Stephen G. AU - Basnyat, Buddha AU - Bekker, Adrie AU - Bender, Rose Grace AU - Berkley, James Alexander AU - Adhisivam, Bethou AU - Bielicki, Julia Anna AU - Boonkasidecha, Suppawat AU - Bukosia, James AU - Carvalheiro, Cristina Gardonyi AU - Castañeda-Orjuela, Carlos Andrés AU - Chansamouth, Vilada AU - Chaurasia, Suman AU - Chiurchiù, Sara AU - Chowdhury, Fazle Rabbi AU - Donatien, Rafai Clotaire AU - Cook, Aislinn AU - Cooper, Ben Symons AU - Cressey, Tim Roy AU - Criollo-Mora, Elia AU - Cunningham, Matthew W. AU - Darboe, Saffiatou AU - Day, Nicholas AU - Luca, Maia De AU - Dokova, Klara Georgieva AU - Dramowski, Angela AU - Dunachie, Susanna Jane AU - Thuy, Duong Bich AU - Eckmanns, Tim AU - Eibach, Daniel AU - Emami, Amir AU - Feasey, Nicholas AU - Fisher-Pearson, Natasha AU - Forrest, Karen AU - Garcia, Coralith AU - Garrett, Denise Oliveira AU - Gastmeier, Petra AU - Giref, Ababi Zergaw AU - Greer, Rachel Claire AU - Gupta, Vikas AU - Haller, Sebastian AU - Haselbeck, Andrea AU - Hay, Simon Iain AU - Holm, Marianne AU - Hopkins, Susan AU - Hsia, Yingfen AU - Iregbu, Kenneth Chukwuemeka AU - Jacobs, Jan Adriaan AU - Jarovsky, Daniel AU - Javanmardi, Fatemeh AU - Jenney, Adam W. J. AU - Khorana, Meera AU - Khusuwan, Suwimon AU - Kissoon, Niranjan “Tex” AU - Kobeissi, Elsa AU - Kostyanev, Tomislav AU - Krapp, Fiorella AU - Krumkamp, Ralf AU - Kumar, Ajay M. V. AU - Kyu, Hmwe Hmwe AU - Lim, Cherry AU - Lim, Kruy AU - Limmathurotsakul, Direk AU - Loftus, Michael J. AU - Lunn, Miles AU - Ma, Jianing AU - Manoharan, Anand AU - Marks, Florian AU - May, Jürgen AU - Mayxay, Mayfong AU - Mturi, Neema AU - Múnera‐Huertas, Tatiana AU - Musicha, Patrick AU - Musila, Lilian A AU - Mussi‐Pinhata, Marisa Márcia AU - Naidu, Ravi Narayan AU - Nakamura, Tomoka AU - Nanavati, Ruchi Nimish AU - Nangia, Sushma AU - Newton, Paul N. AU - Ngoun, Chanpheaktra AU - Novotney, Amanda AU - Nwakanma, Davis C. AU - Obiero, Christina W. AU - Ochoa, Theresa Jean AU - Olivas‐Martínez, Antonio AU - Olliaro, Piero AU - Ooko, Edna AU - Ortíz‐Brizuela, Edgar AU - Ounchanum, Pradthana AU - Pak, Gi Deok AU - Paredes, José Luis AU - Peleg, Anton Yariv AU - Perrone, Carlo AU - Phe, Thong AU - Phommasone, Koukeo AU - Plakkal, Nishad AU - Ponce‐de‐León, Alfredo AU - Raad, Mathieu AU - Ramdin, Tanusha AU - Rattanavong, Sayaphet AU - Riddell, Amy AU - Roberts, Tamalee AU - Robotham, Julie V. AU - Roca, Anna AU - Rosenthal, Víctor AU - Rudd, Kristina E. AU - Russell, Neal AU - Sader, Helio Silva AU - Saengchan, Weerawut AU - Schnall, Jesse AU - Scott, John A. AU - Seekaew, Samroeng AU - Sharland, Mike AU - Shivamallappa, Madhusudhan AU - Sifuentes‐Osornio, José AU - Simpson, Andrew J. H. AU - Steenkeste, Nicolas AU - Stewardson, Andrew James AU - Stoeva, Temenuga Zhekova AU - Tasak, Nidanuch AU - Thaiprakong, Areerat AU - Thwaites, Guy Edward AU - Tigoi, Caroline AU - Turner, Claudia L. AU - Turner, Paul AU - Doorn, H. Rogier van AU - Velaphi, Sithembiso AU - Vongpradith, Avina AU - Vongsouvath, Manivanh AU - Vu, Huong T L AU - Walsh, Timothy AU - Walson, Judd L. AU - Waner, Seymour AU - Wangrangsimakul, Tri AU - Wannapinij, Prapass AU - Wozniak, Teresa Maria AU - Sharma, Tracey E M W Young AU - Yu, Kalvin C. AU - Zheng, Peng AU - Sartorius, Benn K. D. AU - López, Alan D AU - Stergachis, Andy S. AU - Moore, Catrin E. AU - Dolecek, Christiane AU - Naghavi, Mohsen TI - Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis JO - The Lancet VL - 399 IS - 10325 SP - 629 EP - 655 PY - 2022 DA - 2022/01/19 DO - 10.1016/s0140-6736(21)02724-0 UR - https://doi.org/10.1016/s0140-6736(21)02724-0 ER -
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