International journal of antimicrobial agents · 2026
Global burden of antimicrobial resistance in lower respiratory infections: A systematic analysis for the Global Burden of Disease Study 2021.
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Qin Weidong, Wang Hao, Lv Kunpeng, Liu Sa, Ma Tengzhi, Sang Shaowei, Chen Yuguo
Аннотация
OBJECTIVES: To provide the comprehensive assessment of the global and regional burden associated with and attributable to antimicrobial resistance (AMR) in lower respiratory infections (LRIs) from 1990 to 2021.
METHODS: Using data from the Global Burden of Disease 2021 study, we analysed the global and regional burden of AMR-associated and AMR-attributable LRI mortality from 1990 to 2021. The analysis covered 74 pathogen-drug combinations. Trends in age-standardised mortality rates (ASMRs) were quantified using the estimated annual percentage change (EAPC).
RESULTS: In 2021, AMR was associated with 1.64 million (95% uncertainty interval [UI]: 1.44, 1.84) global LRI deaths and directly attributable to 0.40 million (0.34, 0.46). Although ASMRs declined significantly from 1990 to 2021 (EAPC: -2.31 for AMR-associated, -2.05 for AMR-attributable), the absolute burden shifted markedly by age, with substantial reductions in children under five contrasting with rising deaths among adults ≥60 y. Globally, males exhibited a higher mortality burden than females, although the magnitude and statistical significance of this disparity varied by age group. Sub-Saharan Africa experienced the highest regional burden. Six pathogens-Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Escherichia coli-accounted for >92.1% of deaths. While resistance of S. pneumoniae to trimethoprim-sulfamethoxazole and macrolides contributed the most AMR-associated deaths globally, β-lactam resistance emerged as the leading cause of AMR-attributable deaths. This burden was driven by resistant strains of S. pneumoniae, alongside critical Gram-negative pathogens including A. baumannii, K. pneumoniae and P. aeruginosa.
CONCLUSIONS: These findings highlight successful reductions in paediatric AMR mortality and reveal urgent gaps in addressing Gram-negative resistance, the growing geriatric burden and pervasive disparities. Equitable vaccine access, enhanced diagnostics and targeted interventions are critical to mitigating the global AMR burden in LRIs.
METHODS: Using data from the Global Burden of Disease 2021 study, we analysed the global and regional burden of AMR-associated and AMR-attributable LRI mortality from 1990 to 2021. The analysis covered 74 pathogen-drug combinations. Trends in age-standardised mortality rates (ASMRs) were quantified using the estimated annual percentage change (EAPC).
RESULTS: In 2021, AMR was associated with 1.64 million (95% uncertainty interval [UI]: 1.44, 1.84) global LRI deaths and directly attributable to 0.40 million (0.34, 0.46). Although ASMRs declined significantly from 1990 to 2021 (EAPC: -2.31 for AMR-associated, -2.05 for AMR-attributable), the absolute burden shifted markedly by age, with substantial reductions in children under five contrasting with rising deaths among adults ≥60 y. Globally, males exhibited a higher mortality burden than females, although the magnitude and statistical significance of this disparity varied by age group. Sub-Saharan Africa experienced the highest regional burden. Six pathogens-Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Escherichia coli-accounted for >92.1% of deaths. While resistance of S. pneumoniae to trimethoprim-sulfamethoxazole and macrolides contributed the most AMR-associated deaths globally, β-lactam resistance emerged as the leading cause of AMR-attributable deaths. This burden was driven by resistant strains of S. pneumoniae, alongside critical Gram-negative pathogens including A. baumannii, K. pneumoniae and P. aeruginosa.
CONCLUSIONS: These findings highlight successful reductions in paediatric AMR mortality and reveal urgent gaps in addressing Gram-negative resistance, the growing geriatric burden and pervasive disparities. Equitable vaccine access, enhanced diagnostics and targeted interventions are critical to mitigating the global AMR burden in LRIs.