Trends in mortality, pathogen distribution, and antimicrobial resistance of peritoneal and intra-abdominal infections from 1990 to 2021: a cross-sectional analysis of the MICROBE database.

BACKGROUND

Peritoneal and intra-abdominal infections (IAIs) are a major cause of morbidity and mortality in surgical patients, with rising antimicrobial resistance (AMR) threatening surgical safety. This study mapped global and regional patterns in IAI burden and resistant pathogens to inform evidence-based surgical practice.

METHODS

Global IAI deaths, disability-adjusted life years, and distributions of key AMR pathogens were analysed from 1990 to 2021 across 21 Global Burden of Disease (GBD) regions using the Measuring Infectious Causes and Resistance Outcomes for Burden Estimation (MICROBE) database, with future projections through 2050.

RESULTS

IAI-related deaths rose from 394,500 (95% Uncertainty Intervals [UI] 361,200 to 427,800) in 1990 to 646,359 (95% UI 585,349 to 707,369) in 2021, with mortality rates increasing from 7.4 (95% UI 6.8 to 8.0) to 8.2 (95% UI 7.4 to 9.0) per 100,000 population. By 2050, global deaths are projected to decrease slightly by 0.6% to 642,485 (95% UI 552,824 to 750,367). However, this decrease is not seen in all regions. The death count is predicted to rise in Latin America and the Caribbean, while substantial declines are projected for South Asia and Central/Eastern Europe and Central Asia. Escherichia coli was the leading global pathogen, with regional variation: Klebsiella pneumoniae predominated in Sub-Saharan Africa, while Staphylococcus aureus (S. aureus) was most frequent in high-income regions. In 2021, AMR-related deaths approached 329,000 worldwide, with the death rate rising from 3.79 to 4.17 per 100,000. Carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae showed the most rapid increases. Methicillin-resistant S. aureus mortality remained stable, while efforts to control vancomycin-resistant Enterococcus faecium were less effective.

CONCLUSION

The rising and regionally diverse burden of IAIs, exacerbated by increasing AMR, demands robust surgical antimicrobial stewardship and targeted infection control strategies. Tailoring perioperative antibiotics to local resistance patterns and prioritizing effective source control are essential to optimizing surgical outcomes worldwide.