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The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis

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dc.contributor.author Aguilar, GR
dc.contributor.author Swetschinski, LR
dc.contributor.author Weaver, ND
dc.contributor.author Ikuta, KS
dc.contributor.author Mestrovic, T
dc.contributor.author Gray, AP
dc.contributor.author Chung, E
dc.contributor.author Wool, EE
dc.contributor.author Han, C
dc.contributor.author Hayoon, AG
dc.contributor.author Araki, DT
dc.contributor.author Abdollahi, A
dc.contributor.author Abu-Zaid, A
dc.contributor.author Adnan, M
dc.contributor.author Agarwal, R
dc.contributor.author Dehkordi, JA
dc.contributor.author Aravkin, AY
dc.contributor.author Areda, D
dc.contributor.author Azzam, AY
dc.contributor.author Berezin, EN
dc.contributor.author Bhagavathula, AS
dc.contributor.author Bhutta, ZA
dc.contributor.author Bhuyan, SS
dc.contributor.author Browne, AJ
dc.contributor.author Castañeda-Orjuela, CA
dc.contributor.author Chandrasekar, EK
dc.contributor.author Ching, PR
dc.contributor.author Dai, XC
dc.contributor.author Darmstadt, GL
dc.contributor.author De la Hoz, FP
dc.contributor.author Diao, N
dc.contributor.author Diaz, D
dc.contributor.author dos Santos, WM
dc.contributor.author Eyre, D
dc.contributor.author García Apac, Coralith Marlinda
dc.contributor.author Haines-Woodhouse, G
dc.contributor.author Hassen, MB
dc.contributor.author Henry, NJ
dc.contributor.author Hopkins, S
dc.contributor.author Hossain, MM
dc.contributor.author Iregbu, KC
dc.contributor.author Iwu, CCD
dc.contributor.author Jacobs, JA
dc.contributor.author Janko, MM
dc.contributor.author Jones, R
dc.contributor.author Karaye, IM
dc.contributor.author Khalil, IA
dc.contributor.author Khan, IA
dc.contributor.author Khan, T
dc.contributor.author Khubchandani, J
dc.contributor.author Khusuwan, S
dc.contributor.author Kisa, A
dc.contributor.author Koyaweda, GW
dc.contributor.author Krapp Lopez, Fiorella del Carmen
dc.contributor.author Kumaran, EAP
dc.contributor.author Kyu, HH
dc.contributor.author Lim, SS
dc.contributor.author Liu, XF
dc.contributor.author Luby, S
dc.contributor.author Maharaj, SB
dc.contributor.author Maronga, C
dc.contributor.author Martorell, M
dc.contributor.author May, J
dc.contributor.author McManigal, B
dc.contributor.author Mokdad, AH
dc.contributor.author Moore, CE
dc.contributor.author Mostafavi, E
dc.contributor.author Murillo-Zamora, E
dc.contributor.author Mussi-Pinhata, MM
dc.contributor.author Nanavati, R
dc.contributor.author Nassereldine, H
dc.contributor.author Natto, ZS
dc.contributor.author Qamar, FN
dc.contributor.author Nunez-Samudio, V
dc.contributor.author Ochoa Woodell, Theresa Jean
dc.contributor.author Ojo-Akosile, TR
dc.contributor.author Olagunju, AT
dc.contributor.author Olivas-Martinez, A
dc.contributor.author Ortiz-Brizuela, E
dc.contributor.author Ounchanum, P
dc.contributor.author Paredes Sosa, José Luis
dc.contributor.author Patthipati, VS
dc.contributor.author Pawar, S
dc.contributor.author Pereira, M
dc.contributor.author Pollard, A
dc.contributor.author Ponce-De-Leon, A
dc.contributor.author Prates, EJS
dc.contributor.author Qattea, I
dc.contributor.author Reyes, LF
dc.contributor.author Roilides, E
dc.contributor.author Rosenthal, VD
dc.contributor.author Rudd, KE
dc.contributor.author Sangchan, W
dc.contributor.author Seekaew, S
dc.contributor.author Seylani, A
dc.contributor.author Shababi, N
dc.contributor.author Sham, S
dc.contributor.author Sifuentes-Osornio, J
dc.contributor.author Singh, H
dc.contributor.author Stergachis, A
dc.contributor.author Tasak, N
dc.contributor.author Tat, NY
dc.contributor.author Thaiprakong, A
dc.contributor.author Valdez, PR
dc.contributor.author Yada, DY
dc.contributor.author Yunusa, I
dc.contributor.author Zastrozhin, MS
dc.contributor.author Hay, SI
dc.contributor.author Dolecek, C
dc.contributor.author Sartorius, B
dc.contributor.author Murray, CJL
dc.contributor.author Naghavi, M
dc.contributor.author Antimicrobial Resistance Colla
dc.date.accessioned 2023-12-07T22:33:25Z
dc.date.available 2023-12-07T22:33:25Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/14729
dc.description.abstract Background Antimicrobial resistance (AMR) is an urgent global health challenge and a critical threat to modern health care. Quantifying its burden in the WHO Region of the Americas has been elusive-despite the region's long history of resistance surveillance. This study provides comprehensive estimates of AMR burden in the Americas to assess this growing health threat.Methods Weestimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen-drug combinations for countries in the WHO Region of the Americas in 2019. We obtained data from mortality registries, surveillance systems, hospital systems, systematic literature reviews, and other sources, and applied predictive statistical modelling to produce estimates of AMR burden for all countries in the Americas. Five broad components were the backbone of our approach: the number of deaths where infection had a role, 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 pathogens resistant to an antibiotic class, and the excess risk of mortality (or duration of an infection) associated with this resistance. We then used these components to estimate the disease burden by applying two counterfactual scenarios: deaths attributable to AMR (compared to an alternative scenario where resistant infections are replaced with susceptible ones), and deaths associated with AMR (compared to an alternative scenario where resistant infections would not occur at all). 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. Findings We estimated 569,000 deaths (95% UI 406,000-771,000) associated with bacterial AMR and 141,000 deaths (99,900-196,000) attributable to bacterial AMR among the 35 countries in the WHO Region of the Americas in 2019. Lower respiratory and thorax infections, as a syndrome, were responsible for the largest fatal burden of AMR in the region, with 189,000 deaths (149,000-241,000) associated with resistance, followed by bloodstream infections (169,000 deaths [94,200-278,000]) and peritoneal/intra-abdominal infections (118,000 deaths [78,600-168,000]). The six leading pathogens (by order of number of deaths associated with resistance) were Staphylococcus aureus , Escherichia coli , Klebsiella pneumoniae , Streptococcus pneumoniae , Pseudomonas aeruginosa , and Acinetobacter baumannii. Together, these pathogens were responsible for 452,000 deaths (326,000-608,000) associated with AMR. Methicillin-resistant S. aureus predominated as the leading pathogen-drug combination in 34 countries for deaths attributable to AMR, while aminopenicillin-resistant E. coli was the leading pathogen-drug combination in 15 countries for deaths associated with AMR. Interpretation Given the burden across different countries, infectious syndromes, and pathogen-drug combinations, AMR represents a substantial health threat in the Americas. Countries with low access to antibiotics and basic health-care services often face the largest age-standardised mortality rates associated with and attributable to AMR in the region, implicating specific policy interventions. Evidence from this study can guide mitigation efforts that are tailored to the needs of each country in the region while informing decisions regarding funding and resource allocation. Multisectoral and joint cooperative efforts among countries will be a key to success in tackling AMR in the Americas. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet Regional Health. Americas
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Antimicrobial resistance en_US
dc.subject AMR en_US
dc.subject Bacteria en_US
dc.subject Disease burden en_US
dc.subject Mortality en_US
dc.subject Americas en_US
dc.subject.mesh Farmacorresistencia Microbiana
dc.subject.mesh Bacterias
dc.subject.mesh Costo de Enfermedad
dc.subject.mesh Mortalidad
dc.subject.mesh Américas
dc.title The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.lana.2023.100561
dc.relation.issn 2667-193X

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