Burden and Economic Impact of Antimicrobial Resistance in Acinetobacter baumannii in Iran: A 2000-2021 Analysis

Acinetobacter baumannii is a major contributor to antimicrobial resistance (AMR), particularly in hospitals. Its rising resistance presents significant clinical and economic concerns. This study evaluated the national burden and economic impact of A. baumannii infections in Iran from 2000 to 2021 using GBD 2021 AMR data.

We estimated mortality and disability-adjusted life years (DALYs) per 100,000 people with 95% UIs under two scenarios: resistant infections replaced by susceptible ones (attributable burden) and replaced by no infection (associated burden). Economic burden was calculated using GDP per capita and purchasing power parity (PPP)-adjusted estimates.

From 2000 to 2021, total associated DALYs declined from 90,391.9 (95% UI: 80,178.0-100,605.9) to 69,740.5 (65,132.4-74,348.6) and attributable DALYs from 35,284.5 (30,843.1-39,725.9) to 28,085.9 (25,415.9-30,755.9). However, associated deaths increased from 2019.5 (1870.3-2168.8) to 2523.7 (2322.5-2724.9), with neonates and individuals aged 50 years and older most affected. Bloodstream and lower respiratory infections contributed most to DALYs. Resistance remained highest for cephalosporins and carbapenems. The economic burden peaked in 2010 at 584.6 million PPP and decreased to 435.2 million in 2021.

Although disease burden declined, rising mortality and resistance trends highlight the need for stronger infection control and stewardship to reduce A. baumannii-related AMR in Iran.