Global spatiotemporal dynamics of mortality from carbapenem-resistant Gram-negative infections over the past three...

Carbapenem-resistant Gram-negative infections are a global threat, yet their long-term pathogen-specific mortality dynamics and pandemic-era deviations remain unclear. In this secondary modelling analysis, we evaluate associated mortality under a no-infection counterfactual and attributable mortality under a drug-susceptible infection counterfactual for carbapenem-resistant Gram-negative infections overall and across seven constituent pathogen groups in 204 countries and territories from 1990 to 2021. Using age-period-cohort decomposition and Bayesian counterfactual modelling, we estimate 1.03 million associated (95% uncertainty interval, 0.90-1.17 million) and 0.22 million attributable (0.17-0.27 million) deaths from these infections in 2021. From 1990 to 2019, overall associated and attributable mortality rates increased by 0.82% (95% confidence interval, 0.77-0.87) and 0.90% (0.85-0.95) per year, respectively. South Asia has the fastest-rising associated and attributable mortality, whereas high-income regions decline. Among constituent pathogens, Klebsiella pneumoniae shows the fastest increase in mortality rates, while Pseudomonas aeruginosa shows declining associated but slightly rising attributable mortality. During 2020-2021, overall associated mortality falls 4.71% below pre-pandemic counterfactual projections, whereas attributable mortality does not change significantly. Here, we show divergent mortality trajectories by region, pathogen, and metric, motivating targeted, dual-metric surveillance and intervention strategies.