Global burden of antimicrobial resistance in lower respiratory infections in 2021: A systematic analysis

The research aimed to provide a worldwide evaluation of antimicrobial resistance (AMR), focusing specifically on AMR related to lower respiratory infections (LRI).

The data were derived from the Global Antimicrobial Resistance Burden 2021 (GARB 2021). Two counterfactuals were utilized to estimate the deaths attributable to AMR and the deaths associated with AMR. The primary estimation process involved various statistical methodologies, including polynomial estimation and ensemble spatiotemporal Gaussian regression models. Using the DisMod-MR 2.1 modeling framework, the incidence and prevalence of LRI were estimated, the mortality rates were subsequently calculated, and stratified by pathogens, regions, and age groups. In addition, these indexes were identified and visualized to present global burden of AMR.

In 2021, there were 20.89 (95% uncertain interval: 18.27-23.50) deaths per 100 000 individuals associated with AMR in LRI, and 5.05 (95% UI: 4.29-5.51) deaths per 100 000 individuals attributable to AMR in LRI. Trimethoprim-sulfamethoxazole-resistant S. pneumoniae exhibited the highest mortality rate of 5.15 (95% UI: 3.96- 6.34) deaths per 100 000 individuals associated with AMR, while Carbapenem -resistant S. pneumoniae exhibited the highest mortality rate of 0.66 (95% UI: 0.45-0.86) deaths per 100 000 individuals attributable to AMR. S. pneumoniae exhibited the greatest burden of AMR, followed by S. aureus. Central Sub-Saharan Africa had the highest AMR burden, with mortality rates of 73.75 (95% UI: 56.61-90.89) deaths per 100 000 individuals associated with AMR and 17.73 (95% UI: 12.71-2.74) deaths per 100 000 individuals attributable to AMR, followed by Eastern Sub-Saharan Africa and Western Sub-Saharan Africa. The individuals aged under 5 and over 65 years exhibited high prevalence of antibiotic resistance especially to Carbapenems, Methicillin, and Fluoroquinolones.

AMR in the LRI is still a pressing global health issue, particularly in developing countries and neonatal age groups. Global interventions need to be taken to reduce the prevalence of AMR.