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Death rates per 100 000 attributable to AMR, all ages, 1990, 2021, 2050 (A) Death rate attributable to AMR, all ages, 1990. (B) Death rate attributable to AMR, all ages, 2021. (C) Death rate attributable to AMR, all ages, 2050. AMR=antimicrobial resistance.
Source publication
Background
Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce com...
Contexts in source publication
Context 1
... western sub-Saharan Africa, 58·9% (54·8-63·0) of the attributable AMR mortality occurred in children younger than 5 years, and 15·8% (13·5-18·2) occurred in adults 70 years and older in 2021. In comparison, in the (Figure 3 continues on next page) high-income Asia Pacific region, 0·181% (0·1490-0·222) of the attributable AMR mortality occurred in children younger than 5 years and 83·9% (81·7-86·1) of the attributable AMR mortality was in adults 70 years and older for 2021 ( figure 2; figure 3B). Table 3 shows the number of deaths attributable to and associated with AMR at the regional level. ...
Context 2
... children younger than 5 years, the pathogens with the largest number of deaths attributable to AMR in 2021 were K pneumoniae, S pneumoniae, and E coli ( figure 3). The greatest reduction in AMR deaths in children younger than 5 years globally was due to resistant S pneumoniae, which decreased from 158 000 attributable (95% UI 106 000-209 000) deaths and 801 000 associated (604 000-997 000) deaths in 1990, to 35 100 attributable deaths (24 000-46 200) and 176 000 associated (133 000-220 000) deaths in 2021. ...
Context 3
... western sub-Saharan Africa, 58·9% (54·8-63·0) of the attributable AMR mortality occurred in children younger than 5 years, and 15·8% (13·5-18·2) occurred in adults 70 years and older in 2021. In comparison, in the (Figure 3 continues on next page) high-income Asia Pacific region, 0·181% (0·1490-0·222) of the attributable AMR mortality occurred in children younger than 5 years and 83·9% (81·7-86·1) of the attributable AMR mortality was in adults 70 years and older for 2021 ( figure 2; figure 3B). Table 3 shows the number of deaths attributable to and associated with AMR at the regional level. ...
Context 4
... children younger than 5 years, the pathogens with the largest number of deaths attributable to AMR in 2021 were K pneumoniae, S pneumoniae, and E coli ( figure 3). The greatest reduction in AMR deaths in children younger than 5 years globally was due to resistant S pneumoniae, which decreased from 158 000 attributable (95% UI 106 000-209 000) deaths and 801 000 associated (604 000-997 000) deaths in 1990, to 35 100 attributable deaths (24 000-46 200) and 176 000 associated (133 000-220 000) deaths in 2021. ...
Context 5
... western sub-Saharan Africa, 58·9% (54·8-63·0) of the attributable AMR mortality occurred in children younger than 5 years, and 15·8% (13·5-18·2) occurred in adults 70 years and older in 2021. In comparison, in the (Figure 3 continues on next page) high-income Asia Pacific region, 0·181% (0·1490-0·222) of the attributable AMR mortality occurred in children younger than 5 years and 83·9% (81·7-86·1) of the attributable AMR mortality was in adults 70 years and older for 2021 ( figure 2; figure 3B). Table 3 shows the number of deaths attributable to and associated with AMR at the regional level. ...
Context 6
... children younger than 5 years, the pathogens with the largest number of deaths attributable to AMR in 2021 were K pneumoniae, S pneumoniae, and E coli ( figure 3). The greatest reduction in AMR deaths in children younger than 5 years globally was due to resistant S pneumoniae, which decreased from 158 000 attributable (95% UI 106 000-209 000) deaths and 801 000 associated (604 000-997 000) deaths in 1990, to 35 100 attributable deaths (24 000-46 200) and 176 000 associated (133 000-220 000) deaths in 2021. ...
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Background
The Caribbean lacks recent comprehensive antimicrobial resistance data to inform clinicians and decision-makers. This study aims to provide a snapshot of susceptibility trends for pathogens on Curaçao, an island in the southern Caribbean.
Methods
We analyzed susceptibility data of bacterial pathogens isolated from samples submitted from...
Citations
... This study reveals a high prevalence of tetra-, penta-, and hepta-resistant patterns in environmental and pork isolates, which poses a significant public health threat due to potential treatment failures after simple infections caused by MDR isolates. These findings were consistent with various global investigations demonstrating a high incidence of MDR patterns among Salmonella strains isolated from different sources [19,30]. The extensive use of antibiotics in the medical and veterinary sectors that resulted in a high AMR by exerting a selection pressure against the used antimicrobials. ...
... Due to the indiscriminate use of broadspectrum antibiotics for the initial treatment of UTIs, multidrug-resistance uropathogens have significantly increased [12]. In 2021, an estimated 4.71 million deaths were associated with infections caused by antibiotic-resistant pathogens, with an estimated 1.14 million deaths attributable to these infections [118]. In 2024, the World Health Organization included carbapenem-and cephalosporin-resistant (e.g., ESBL-producing) Enterobacterales as pathogens that pose the highest threat to public health [119]. ...
Urinary tract infections (UTIs) are common bacterial infections and present with heterogeneous clinical phenotypes. Whereas many uncomplicated UTIs resolve spontaneously or with antibiotic treatment, a complicated UTI (cUTI) presents with greater morbidity and a higher risk of treatment failures. The goal of this study was to estimate the real-world epidemiology of cUTI, including acute pyelonephritis (AP) and catheter-associated UTIs (CAUTIs), and its associated mortality internationally.
A systematic literature search was conducted using PubMed, Embase, Cochrane, and EconLit databases for relevant articles published between July 2013 and July 2023 covering Europe and the following countries: France, Italy, Germany, Spain, the UK, China, Japan, and the US (US). Search terms relating to cUTI, AP, CAUTI, outcomes of interest (epidemiology), and real-world research designs were used. There were no language limitations (protocol registry: PROSPERO-CRD42023454794).
Database searches yielded 1014 unique records, of which 91 met the prespecified inclusion criteria; bibliography and conference abstract searches yielded 27 additional records for a total of 118 records for inclusion. Disease presentation and reported outcomes varied widely across studies, and most studies reporting incidence and prevalence of cUTI were from the US (21 of 29). No studies reporting incidence or prevalence rates of cUTI in China, Germany, or the UK were identified. Overall, high antibiotic resistance rates were reported in both inpatient and outpatient settings. The inpatient cohort mortality rates were highly variable (0–50%) depending on the patient population.
While disease presentation and reported outcomes varied widely across studies, cUTIs represent a considerable burden in terms of incidence, prevalence, drug resistance, and mortality, yet vast knowledge gaps remain in the literature. There is a crucial need to address these gaps to effectively evaluate new treatments and improve future analyses of cUTI burden and outcomes.
... The incidence of antimicrobial-resistant infections is increasing globally, with a recent systematic analysis forecasting that the antimicrobial resistance (AMR) burden will increase to 1.9 million attributable deaths and 8.2 million associated deaths by 2050. 1 Methicillin-resistant Staphylococcus aureus (MRSA) was the organism attributed to the most AMR-related deaths in 2019, estimated at more than 100,000. 2 Overuse and inappropriate use of antimicrobials are the key drivers of AMR. Results of the 2022 Surgical National Antimicrobial Prescribing Survey (SNAPS), a point prevalence survey assessing appropriateness of antimicrobial use in Australia, suggests that the overall rate of appropriate antimicrobial prophylaxis per surgical episode remains low (55.3%), with appropriateness of prescribing for some surgical craft groups being as low as (34%). ...
Objective:To investigate the use of rifampicin vials in Australian operating theaters (OT) to determine the method of administration and rationale for use.
Methods:Retrospective (2022 and 2023) OT usage data for rifampicin 600 mg vials were analyzed to compare trends in use between Australian hospitals and between jurisdictions. An audit of rifampicin vials used in OT during 2023 was conducted at a large tertiary hospital.
Results:Fifty-nine of 248 hospitals (24%) contributing data to the National Antimicrobial Utilisation Surveillance Program recorded OT use of rifampicin vials during 2022 and 2023. Excluding hospitals with no usage, the median use was 7 vials/annum/per hospital (IQR: 2–32). A wide variation in use was seen between Australian states and territories. An audit of OT use in 2023 at a large tertiary hospital found poor documentation of topical use; in most cases, documentation was in the operation note only, with no documentation on the medication charts, medical notes, or the anesthetic record. Of 33 rifampicin vials used in 2023, documented topical use was identified for 10 individual patients only, 4 of whom had a confirmed Staphylococcus aureus infection (1 methicillin-resistant and 3 methicillin-susceptible).
Conclusion:Off-label, topical use of rifampicin during surgery is not uncommon in some Australian hospitals despite limited evidence of safety or efficacy. Given the potential for resistance, surgical use of rifampicin should be restricted to a named-patient basis, under the guidance of an infectious disease specialist/clinical microbiologist. Documentation of all medication use is recommended for patient safety.
... The findings of this study highlight the need to develop and implement appropriate wastewater management plans, upgrade existing wastewater treatment practices and facilities, and improve regulatory guidelines with a particular focus on high-risk substances and locations that pose the greatest risk. Our global model predicts high antibiotic concentrations in regions already impacted by antibiotic resistance, such as Southeast and South Asia (105,107). Areas that exhibit the most widespread distribution of exposed river courses are those with a high population density and high antibiotic consumption and coincide with regions that offer only poor access to wastewater treatment and/or are subject to water scarcity (i.e. causing a lack of dilution in receiving waters). ...
The presence of antibiotics in surface waters poses risks to aquatic ecosystems and human health due to their toxicity and influence on antimicrobial resistance. After human consumption and partial metabolism, antibiotic residues are excreted and undergo complex accumulation and decay processes along their pathway from wastewater to natural river systems. Here, we use a global contaminant fate model to estimate that of the annual human consumption of the 40 most used antibiotics (29,200 tonnes), 8,500 tonnes (29%) are released into the river system and 3,300 tonnes (11%) reach the world's oceans or inland sinks. Even when only domestic sources are considered (i.e. not including veterinary or industrial sources), we estimate that 6 million km of rivers worldwide are subject to total antibiotic concentrations in excess of thresholds that are protective of ecosystems and resistance promotion during low streamflow conditions, with the dominant contributors being amoxicillin, ceftriaxone, and cefixime. Therefore, it is of concern that human consumption alone represents a significant risk for rivers across all continents, with the largest extents found in Southeast Asia. Global antibiotic consumption has grown rapidly over the last 15 years and continues to increase, particularly in low- and middle-income countries, requiring new strategies to safeguard water quality and protect human and ecosystem health.
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Background
Bloodstream Infection(BSI) are one of the leading causes of infection-related mortality worldwide. However, epidemiological data related to BSI in China remain very limited.
Methods
Based on the Global Burden of Disease(GBD) database, a systematic analysis was conducted on the epidemic trends, pathogen spectrum, and the current status of Antimicrobial Resistance(AMR) related to BSI in China for the year 2021. Additionally, an Autoregressive Integrated Moving Average(ARIMA) time series model was constructed to predict the trend of the disease burden associated with BSI in China from 2022 to 2035.
Results
In terms of pathogens, the top five pathogens causing deaths due to BSI in China are as follows: Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. There are significant differences in the pathogens causing BSI across different age groups. The disease burden is heaviest in the elderly population aged 70 and above. Among children under five years old, Staphylococcus aureus, Streptococcus pneumoniae, and Candida species are predominant. From 1990 to 2021, although there has been a gradual decline in mortality rates due to BSI across different age groups (with an approximately 52.4% reduction in age-standardized rates), the disease burden of BSI increases with age. This is especially evident in the population aged 70 and above, where the burden of disease is significantly higher than in other age groups. For instance, in 2021, the mortality rate for individuals aged 70–74 was 149.29 (per 100 K), while for those aged 95 and older, the mortality rate reached as high as 896.71 (per 100 K). On a global scale, the disease burden caused by BSI in China is at a moderate level. According to time series model projections, the mortality burden of BSI in China shows a complex trend toward 2035: the crude mortality rate across all age groups is expected to increase by approximately 14.26%, whereas the age-standardized mortality rate and Disability-Adjusted Life Years(DALYs) are projected to decrease significantly. Notably, the mortality burden is expected to decline most prominently in the 70 + and under 5 age groups, while the 25–44 age group is projected to see minimal change. Conversely, the mortality rates for the 5–49 age group are anticipated to increase slightly.
Conclusion
Staphylococcus aureus and Escherichia coli are key pathogens contributing to the high mortality burden of BSI. Additionally, the heavy burden associated with AMR poses significant challenges to clinical treatment. From 1990 to 2021, the age-standardized mortality rate mortality of BSI patients is gradually decreasing, and the change in BSI mortality will be mainly affected by the changes in population size and age structure. The forecast analysis for 2022–2035 finds that the death burden of the elderly will be the heaviest, and the mortality of people aged 5–49 years will increase slightly. BSI and its related health problems are still major challenges and need continuous attention.
Clinical trial
Inapplicability.
... These tiny microorganisms have resulted in countless deaths throughout history [4,5]. ...
Microbial pathogens are responsible for affecting billions of people around the globe which results in large numbers of mortality. There are numerous techniques for controlling the pathogenicity caused by these microorganisms. The individual genes, proteins, and their interactions have been extensively studied by traditional approaches to understand and combat microbial disease. Still omics have evolved a new and powerful strategy that can provide information about the adaptation of microorganisms to diverse environments. Omics technologies use genomic, transcriptomic, proteomic, and metabolomic capacities for molecular insight into the microbial pathogen. Expertise in genomics identifies important genes for virulence and possible resistance against antibiotics. The study of transcriptomics helps to study the regulation of microbial organisms and their association with hosts which helps in developing new therapies and vaccines. Studying proteins helps in finding therapeutic targets to cure an illness. Following this, studying metabolism refers to studying the metabolism of the particular illness which provides certain diagnostics, as well as treatment results. Furthermore, therapeutic peptides are employed in combination therapies and demonstrate antibacterial action, broad spectrum activity, target selectivity, immunomodulatory effects, and biofilm suppression. Therapeutic peptides provide a promising alternative to conventional antimicrobials and have several advantages such as high specificity and low toxicity. There should be an exploration of the combined potential of omics to enhance the efficacy of diagnostics and therapeutic peptides for prevention. In this review, we discussed how the technology that can identify and manage diseases can aid in managing diseases and pathogenic microbial infections.
... In 2019, infections with bacteria that were antibiotic resistant were responsible for over one million fatalities worldwide and approximately 2,500 deaths in Saudi Arabia. 1,2 It is also estimated that 33,110 deaths in the European Union in 2015 can be attributed to infections with bacteria that were resistant to antimicrobials. 3 Antibiotic resistance is especially dangerous for pediatric patients, as infection with multidrug-resistant (MDR) bacteria increases morbidity and mortality, and the mortality rate due to antibiotic resistant bacteria will only increase without proper intervention. ...
... Bacterial resistance to available antibiotics has increasingly become a cause for concern, endangering global public health (1). The World Health Organization (WHO) has identified antimicrobial resistance (AMR) as one of the top ten global health threats. ...
... Bacterial resistance to available antibiotics has increasingly become a cause for concern, endangering global public health (1). The World Health Organization (WHO) has identified antimicrobial resistance (AMR) as one of the top ten global health threats. ...
Bacterial resistance to available antibiotics has increasingly become a critical issue, necessitating the search for novel inhibitors to combat resistant pathogens, particularly gram-negative bacteria. This bibliometric study aims to analyze the scientific literature on novel inhibitors for extended spectrum beta-lactamase (ESBL) enzymes, identifying the most prolific organizations, authors, journals, countries, and keywords within this research area. Data were retrieved from Dimensions and Scopus databases, with 503 out of 2086 papers (published between 2013 and 2023) meeting the inclusion criteria. Analysis and visualization were performed using R-studio software and VOSviewer©, focusing on article titles, publication years, countries, authors, journals, and keywords. The study found that the United States led in the number of publications (445) and citations (15,889), followed by France and China. The journal Antimicrobial Agents and Chemotherapy published the most articles (171) and received the highest citations. Indiana University Bloomington and Case Western Reserve University from the U.S. were the leading institutions. Robert Bonomo authored the most papers (23), while Karen Bush was the highest-cited author (1,955 citations). Key future research hotspots include "taniborbactam," "xeruborbactam," "enmetazobactam," "VNRX-5236," and "imipenem-relebactam." This study underscores the critical global efforts and contributions in developing novel inhibitors against ESBL enzymes. The findings highlight key authors, influential journals, and emerging research directions that can guide future studies in combating antibiotic resistance among gram-negative bacteria. & Öz: Mevcut antibiyotiklere karşı bakteriyel direnç, özellikle gram-negatif bakterilerde dirençli patojenlerle mücadele için yeni inhibitörlerin bulunmasını zorunlu hale getirmiştir. Bu bibliyometrik çalışmanın amacı, genişletilmiş spektrumlu beta-laktamaz (GSBL) enzimlerine karşı geliştirilen yeni inhibitörler konusundaki bilimsel literatürü analiz etmek, bu araştırma alanındaki en üretken kuruluşları, yazarları, dergileri, ülkeleri ve anahtar kelimeleri belirlemektir. Veriler, 2013-2023 yılları arasında yayımlanan 2086 makaleden 503'ünün dahil edilme kriterlerini karşılayarak Dimensions ve Scopus veritabanlarından alınmıştır. Analiz ve görselleştirme süreçleri, makale başlıkları, yayımlanma yılları, ülkeler, yazarlar, dergiler ve anahtar kelimelere odaklanarak R-studio yazılımı ve VOSviewer© kullanılarak gerçekleştirilmiştir. Çalışma, yayın sayısı (445) ve atıf sayısı (15.889) bakımından Amerika Birleşik Devletleri'nin ilk sırada olduğunu, bunu Fransa ve Çin'in izlediğini ortaya koymuştur. Antimicrobial Agents and Chemotherapy dergisi, en fazla makale (171) yayımlayan ve en yüksek atıf alan dergi olmuştur. Amerika Birleşik Devletleri'nden Indiana University Bloomington ve Case Western Reserve University en önde gelen kurumlar olmuştur. Bonomo Robert en fazla makale (23) yazan kişi iken, Bush Karen en çok atıf (1.955) alan yazardır. Gelecekteki önemli araştırma alanları arasında "taniborbactam," "xeruborbactam," "enmetazobactam," "VNRX-5236" ve "imipenem-relebactam" yer almaktadır. Bu çalışma, GSBL enzimlerine karşı geliştirilen yenilikçi inhibitörler konusunda küresel araştırmaların önemini ve katkılarını vurgulamaktadır. Bulgular, gram-negatif bakterilerde antibiyotik direnciyle mücadelede gelecekteki çalışmalara rehberlik edebilecek önemli yazarları, etkili dergileri ve yükselen araştırma yönlerini vurgulamaktadır.
... However, up to 30%-50% of these antibiotic prescriptions, particularly for upper respiratory tract infections, are unnecessary, fuelling antimicrobial resistance (AMR) [5,6]. AMR results in treatment failure, increased adverse effects and cost to both patients and the healthcare system [7][8][9]. Sub-Saharan African (SSA) countries, including Ghana, appear to have the greatest AMR burden, which needs to be urgently addressed given rising concerns [9]. ...
... AMR results in treatment failure, increased adverse effects and cost to both patients and the healthcare system [7][8][9]. Sub-Saharan African (SSA) countries, including Ghana, appear to have the greatest AMR burden, which needs to be urgently addressed given rising concerns [9]. As a result, AMR is increasingly seen as the next pandemic unless active measures are taken to improve appropriate utilisation [10]. ...
... We are aware of studies in Ghana that have assessed compliance with national guidelines in outpatients for specific conditions, including communityacquired pneumonia and urinary tract infections but not for ENT infections [6,25,34,44]. This is important given the extent of inappropriate prescribing for such infections as well as their impact on morbidity and mortality associated with increasing AMR especially in LMICs [9,21,45]. Fig. 2 Type of antibiotics prescribed (n = 3279) NB: Others include gentamicin, levofloxacin, metronidazole, cefixime, cefuroxime, chloramphenicol, amoxicillin-clavulanic acid + azithromycin, amoxicillin-clavulanic acid + chloramphenicol, amoxicillin-clavulanic acid + metronidazole, cefuroxime + neomycin + amoxicillin-clavulanic acid, amoxicillin-clavulanic acid + metronidazole + neomycin Female gender accounted for the majority of patients who were managed for an ENT condition within the study period whose medical records were extracted. This may be due to the observation that females are better utilizers of health services compared to their male counterparts. ...
Background
Ear, nose and throat (ENT) infections are often associated with high levels of morbidity and mortality. Antibiotic overuse and misuse for most ENT infections have been reported, caused by a lack of expertise or uncertainties to distinguish between infection types. This study sought to determine the level of appropriateness of antibiotics for ENT infections and its associated factors in ambulatory care in a teaching hospital in Ghana to guide future policies given rising resistance rates.
Methods
A retrospective cross-sectional study design was undertaken to audit the quality of antibiotic use in Ho Teaching Hospital, a leading teaching hospital in Ghana, between January 2022 to December 2022. A checklist was designed to extract patient socio-demographic and clinical information from electronic medical records. The main study outcome was the appropriate choice of antibiotics principally in accordance to the Ghana standard treatment guidelines. Descriptive, bivariate and multivariate analyses were performed on the data collected using STATA version 14.
Results
The electronic medical records of a total of 3,279 patients were extracted. The majority (57.88%, n = 1898) of patients were females, median (inter-quartile range) age was 25 [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41–42] years. Ear infections were the commonest (66.24%, n = 2172) diagnosed ENT infection, followed by throat infections (15.74%, n = 516). The most prescribed antibiotic was oral amoxicillin-clavulanic acid together with a topical neomycin-steroid combination (28.00%, n = 918), followed by amoxicillin-clavulanic acid alone (18.69%, n = 613). The appropriate choice of antibiotic for all ENT infections in accordance with treatment guidelines was 60.11%. Inappropriate use of antibiotics was high when more than one antibiotic and World Health Organisation (WHO) ‘Watch’ group antibiotics were prescribed and ear infections compared to the nose and throat infections were treated.
Conclusion
The appropriateness of antibiotic use for ENT infections in this hospital was suboptimal. It was predicted by the type of infection, the number of antibiotics prescribed and the WHO AWaRe group. Antimicrobial stewardship interventions such as clinical audit with feedback and clinician education must be enhanced to among other things identify antibiotic use gaps to help reduce unnecessary use of antibiotics for ENT infections.
