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Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis

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dc.contributor.author Murray, CJL
dc.contributor.author Ikuta, KS
dc.contributor.author Sharara, F
dc.contributor.author Swetschinski, L
dc.contributor.author Aguilar, GR
dc.contributor.author Gray, A
dc.contributor.author Han, C
dc.contributor.author Bisignano, C
dc.contributor.author Rao, P
dc.contributor.author Wool, E
dc.contributor.author Johnson, SC
dc.contributor.author Browne, AJ
dc.contributor.author Chipeta, MG
dc.contributor.author Fell, F
dc.contributor.author Hackett, S
dc.contributor.author Haines-Woodhouse, G
dc.contributor.author Hamadani, BHK
dc.contributor.author Kumaran, EAP
dc.contributor.author McManigal, B
dc.contributor.author Agarwal, R
dc.contributor.author Akech, S
dc.contributor.author Albertson, S
dc.contributor.author Amuasi, J
dc.contributor.author Andrews, J
dc.contributor.author Aravkin, A
dc.contributor.author Ashley, E
dc.contributor.author Bailey, F
dc.contributor.author Baker, S
dc.contributor.author Basnyat, B
dc.contributor.author Bekker, A
dc.contributor.author Bender, R
dc.contributor.author Bethou, A
dc.contributor.author Bielicki, J
dc.contributor.author Boonkasidecha, S
dc.contributor.author Bukosia, J
dc.contributor.author Carvalheiro, C
dc.contributor.author Castaneda-Orjuela, C
dc.contributor.author Chansamouth, V
dc.contributor.author Chaurasia, S
dc.contributor.author Chiurchiu, S
dc.contributor.author Chowdhury, F
dc.contributor.author Cook, AJ
dc.contributor.author Cooper, B
dc.contributor.author Cressey, TR
dc.contributor.author Criollo-Mora, E
dc.contributor.author Cunningham, M
dc.contributor.author Darboe, S
dc.contributor.author Day, NPJ
dc.contributor.author De Luca, M
dc.contributor.author Dokova, K
dc.contributor.author Dramowski, A
dc.contributor.author Dunachie, SJ
dc.contributor.author Eckmanns, T
dc.contributor.author Eibach, D
dc.contributor.author Emami, A
dc.contributor.author Feasey, N
dc.contributor.author Fisher-Pearson, N
dc.contributor.author Forrest, K
dc.contributor.author Garrett, D
dc.contributor.author Gastmeier, P
dc.contributor.author Giref, AZ
dc.contributor.author Greer, RC
dc.contributor.author Gupta, V
dc.contributor.author Haller, S
dc.contributor.author Haselbeck, A
dc.contributor.author Hay, SI
dc.contributor.author Holm, M
dc.contributor.author Hopkins, S
dc.contributor.author Iregbu, KC
dc.contributor.author Jacobs, J
dc.contributor.author Jarovsky, D
dc.contributor.author Javanmardi, F
dc.contributor.author Khorana, M
dc.contributor.author Kissoon, N
dc.contributor.author Kobeissi, E
dc.contributor.author Kostyanev, T
dc.contributor.author Krapp, F
dc.contributor.author Krumkamp, R
dc.contributor.author Kumar, A
dc.contributor.author Kyu, HH
dc.contributor.author Lim, C
dc.contributor.author Limmathurotsakul, D
dc.contributor.author Loftus, MJ
dc.contributor.author Lunn, M
dc.contributor.author Ma, J
dc.contributor.author Mturi, N
dc.contributor.author Munera-Huertas, T
dc.contributor.author Musicha, P
dc.contributor.author Mussi-Pinhata, MM
dc.contributor.author Nakamura, T
dc.contributor.author Nanavati, R
dc.contributor.author Nangia, S
dc.contributor.author Newton, P
dc.contributor.author Ngoun, C
dc.contributor.author Novotney, A
dc.contributor.author Nwakanma, D
dc.contributor.author Obiero, CW
dc.contributor.author Olivas-Martinez, A
dc.contributor.author Olliaro, P
dc.contributor.author Ooko, E
dc.contributor.author Ortiz-Brizuela, E
dc.contributor.author Peleg, AY
dc.contributor.author Perrone, C
dc.contributor.author Plakkal, N
dc.contributor.author Ponce-de-Leon, A
dc.contributor.author Raad, M
dc.contributor.author Ramdin, T
dc.contributor.author Riddell, A
dc.contributor.author Roberts, T
dc.contributor.author VictoriaRobotham, J
dc.contributor.author Roca, A
dc.contributor.author Rudd, KE
dc.contributor.author Russell, N
dc.contributor.author Schnall, J
dc.contributor.author Scott, JAG
dc.contributor.author Shivamallappa, M
dc.contributor.author Sifuentes-Osornio, J
dc.contributor.author Steenkeste, N
dc.contributor.author Stewardson, AJ
dc.contributor.author Stoeva, T
dc.contributor.author Tasak, N
dc.contributor.author Thaiprakong, A
dc.contributor.author Thwaites, G
dc.contributor.author Turner, C
dc.contributor.author Turner, P
dc.contributor.author van Doorn, HR
dc.contributor.author Velaphi, S
dc.contributor.author Vongpradith, A
dc.contributor.author Vu, H
dc.contributor.author Walsh, T
dc.contributor.author Waner, S
dc.contributor.author Wangrangsimakul, T
dc.contributor.author Wozniak, T
dc.contributor.author Zheng, P
dc.contributor.author Sartorius, B
dc.contributor.author Lopez, AD
dc.contributor.author Stergachis, A
dc.contributor.author Moore, C
dc.contributor.author Dolecek, C
dc.contributor.author Naghavi, M
dc.contributor.author Antimicrobial Resistance Collabora
dc.date.accessioned 2022-06-25T20:36:43Z
dc.date.available 2022-06-25T20:36:43Z
dc.date.issued 2022
dc.identifier.uri https://hdl.handle.net/20.500.12866/11884
dc.description.abstract 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 drugresistant 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 subSaharan Africa, at 27·3 deaths per 100000 (20·9–35·3), and lowest in Australasia, at 6·5 deaths (4·3–9·4) per 100000. 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 929000 (660 000–1270 000) deaths attributable to AMR and 3·57 million (2·62–4·78) deaths associated with AMR in 2019. One pathogen–drug combination, meticillinresistant S aureus, caused more than 100 000 deaths attributable to AMR in 2019, while six more each caused 50 000–100000 deaths: multidrug-resistant excluding extensively drug-resistant tuberculosis, third-generation cephalosporin-resistant E coli, carbapenem resistant A baumannii, fluoroquinolone-resistant E coli, carbapenemresistant 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. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject bacterial antimicrobial resistance en_US
dc.subject systematic analysis en_US
dc.title Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S0140-6736(21)02724-0
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#1.06.01
dc.relation.issn 1474-547X


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