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Author Spotlight: Understanding and Detecting Environmental Antimicrobial Resistance by Combining Culture-Based Techniques and Genomics
Published on: July 19, 2024
Global burden, inequalities and projections of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis,
Yu Qiu1, Hongmei Wang1, Kunli Yin1
1Department of Geriatrics, Laboratory of Research and Translation for Geriatric Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China.
Background:
Vancomycin-resistant Enterococcus faecium (VREfm) and Enterococcus faecalis (VREfs) are major antimicrobial resistance threats. Previous assessments rarely distinguished species, limiting understanding of their epidemiology and control. To address this gap, we analysed trends from 1990 to 2021 and projected the burden through 2050 in order to assess the global burden, inequalities, and future patterns of VREfm and VREfs.
Methods:
We analysed deaths and disability-adjusted life years (DALYs) from Measuring Infectious Causes and Resistance Outcomes for Burden Estimation (MICROBE) across 204 countries from 1990 to 2021. Temporal trends were assessed using estimated annual percentage change (EAPC). Associations with the socio-demographic index (SDI), health inequalities, and decomposition of burden changes were examined. Future trends to 2050 were projected using a Bayesian age-period-cohort (BAPC) model.
Results:
In 2021, 11,021 deaths and 353,634 DALYs were attributable to VREfm worldwide, compared with 2991 deaths and 82,025 DALYs attributable to VREfs. Since 1990, VREfm has increased mainly in higher-SDI regions, whereas VREfs has decreased in lower-SDI settings. Based on the BAPC model, VREfm burden is projected to continue rising across all indicators by 2050, while VREfs shows a sustained decline.
Conclusions:
This study demonstrates divergent species-specific trends, with an increasing burden of VREfm and a decline in VREfs. VREfm is concentrated in middle- to high-SDI regions, while VREfs is in lower-SDI regions. For both species, burden peaks in young children and older adults. These divergent patterns necessitate tailored strategies that prioritise young children and older adults, with a focus on hospital infection control and antimicrobial stewardship for VREfm in higher-SDI regions, and on community prevention and One Health approaches for VREfs in lower-SDI regions.
Insights
Antimicrobial resistance from vancomycin-resistant Enterococcus faecium (VREfm) is increasing globally, particularly in higher-income regions. Conversely, vancomycin-resistant Enterococcus faecalis (VREfs) is declining, especially in lower-income areas.
Area of Science:
- Global health
- Infectious diseases
- Antimicrobial resistance
Background:
- Vancomycin-resistant Enterococcus faecium (VREfm) and Enterococcus faecalis (VREfs) are critical antimicrobial resistance threats.
- Previous studies often did not differentiate between VREfm and VREfs, hindering epidemiological understanding and control strategies.
Purpose of the Study:
- To analyze global trends in VREfm and VREfs burden from 1990 to 2021.
- To project future disease burden through 2050.
- To assess global inequalities and patterns of VREfm and VREfs.
Main Methods:
- Analysis of deaths and disability-adjusted life years (DALYs) from the MICROBE database (204 countries, 1990-2021).
- Assessment of temporal trends using Estimated Annual Percentage Change (EAPC).
- Projection of future trends to 2050 using a Bayesian age-period-cohort (BAPC) model.
Main Results:
- In 2021, VREfm caused 11,021 deaths and 353,634 DALYs, while VREfs caused 2991 deaths and 82,025 DALYs.
- VREfm burden increased primarily in high Socio-Demographic Index (SDI) regions, while VREfs decreased in low-SDI regions.
- Projections indicate a continued rise in VREfm burden and a sustained decline in VREfs burden by 2050.
Conclusions:
- VREfm burden is increasing, concentrated in middle- to high-SDI regions, whereas VREfs burden is declining and prevalent in lower-SDI regions.
- Both VREfm and VREfs disproportionately affect young children and older adults.
- Tailored strategies are needed, focusing on hospital infection control and antimicrobial stewardship for VREfm in high-SDI areas, and community prevention and One Health approaches for VREfs in low-SDI areas.
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