December 2024
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71 Reads
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December 2024
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71 Reads
September 2024
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106 Reads
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31 Citations
September 2024
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104 Reads
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54 Citations
September 2024
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102 Reads
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58 Citations
September 2024
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77 Reads
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3 Citations
September 2024
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2,151 Reads
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605 Citations
The Lancet
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 comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts. Methods We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen–drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level. Findings In 2021, we estimated 4·71 million (95% UI 4·23–5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00–1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000–372 000] and 57 200 attributable deaths [34 100–80 300] in 1990, to 550 000 associated deaths [500 000–600 000] and 130 000 attributable deaths [113 000–146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000–834 000) in 1990, to 1·03 million associated deaths (909 000–1·16 million) in 2021, and from 127 000 attributable deaths (82 100–171 000) in 1990, to 216 000 (168 000–264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56–2·26) deaths attributable to AMR and 8·22 million (6·85–9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2–69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5–89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (–6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8–102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08–13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths. Interpretation This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050.
April 2024
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104 Reads
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42 Citations
The Lancet Infectious Diseases
Background Despite a global epidemiological transition towards increased burden of non-communicable diseases, communicable diseases continue to cause substantial morbidity and mortality worldwide. Understanding the burden of a wide range of infectious diseases, and its variation by geography and age, is pivotal to research priority setting and resource mobilisation globally. Methods We estimated disability-adjusted life-years (DALYs) associated with 85 pathogens in 2019, globally, regionally, and for 204 countries and territories. The term pathogen included causative agents, pathogen groups, infectious conditions, and aggregate categories. We applied a novel methodological approach to account for underlying, immediate, and intermediate causes of death, which counted every death for which a pathogen had a role in the pathway to death. We refer to this measure as the burden associated with infection, which was estimated by combining different sources of information. To compare the burden among all pathogens, we used pathogen-specific ratios to incorporate the burden of immediate and intermediate causes of death for pathogens modelled previously by the GBD. We created the ratios by using multiple cause of death data, hospital discharge data, linkage data, and minimally invasive tissue sampling data to estimate the fraction of deaths coming from the pathway to death chain. We multiplied the pathogen-specific ratios by age-specific years of life lost (YLLs), calculated with GBD 2019 methods, and then added the adjusted YLLs to age-specific years lived with disability (YLDs) from GBD 2019 to produce adjusted DALYs to account for deaths in the chain. We used standard GBD methods to calculate 95% uncertainty intervals (UIs) for final estimates of DALYs by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. We provided burden estimates pertaining to all ages and specifically to the under 5 years age group. Findings Globally in 2019, an estimated 704 million (95% UI 610–820) DALYs were associated with 85 different pathogens, including 309 million (250–377; 43·9% of the burden) in children younger than 5 years. This burden accounted for 27·7% (and 65·5% in those younger than 5 years) of the previously reported total DALYs from all causes in 2019. Comparing super-regions, considerable differences were observed in the estimated pathogen-associated burdens in relation to DALYs from all causes, with the highest burden observed in sub-Saharan Africa (314 million [270–368] DALYs; 61·5% of total regional burden) and the lowest in the high-income super-region (31·8 million [25·4–40·1] DALYs; 9·8%). Three leading pathogens were responsible for more than 50 million DALYs each in 2019: tuberculosis (65·1 million [59·0–71·2]), malaria (53·6 million [27·0–91·3]), and HIV or AIDS (52·1 million [46·6–60·9]). Malaria was the leading pathogen for DALYs in children younger than 5 years (37·2 million [17·8–64·2]). We also observed substantial burden associated with previously less recognised pathogens, including Staphylococcus aureus and specific Gram-negative bacterial species (ie, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Helicobacter pylori). Conversely, some pathogens had a burden that was smaller than anticipated. Interpretation Our detailed breakdown of DALYs associated with a comprehensive list of pathogens on a global, regional, and country level has revealed the magnitude of the problem and helps to indicate where research funding mismatch might exist. Given the disproportionate impact of infection on low-income and middle-income countries, an essential next step is for countries and relevant stakeholders to address these gaps by making targeted investments. Funding Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.
February 2024
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2,312 Reads
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77 Citations
The Lancet Global Health
Background A critical and persistent challenge to global health and modern health care is the threat of antimicrobial resistance (AMR). Previous studies have reported a disproportionate burden of AMR in low-income and middle-income countries, but there remains an urgent need for more in-depth analyses across Africa. This study presents one of the most comprehensive sets of regional and country-level estimates of bacterial AMR burden in the WHO African region to date.
August 2023
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99 Reads
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434 Citations
Croatian Medical Journal
Aim: To deliver the most wide-ranging set of antimicrobial resistance (AMR) burden estimates for Croatia to date. Methods: A complex modeling approach with five broad modeling components was used to estimate the disease burden for 12 main infectious syndromes and one residual group, 23 pathogenic bacteria, and 88 bug-drug combinations. This was represented by two relevant counterfactual scenarios: deaths/disability-adjusted life years (DALYs) that are attributable to AMR considering a situation where drug-resistant infections are substituted with sensitive ones, and deaths/DALYs associated with AMR considering a scenario where people with drug-resistant infections would instead present without any infection. The 95% uncertainty intervals (UI) were based on 1000 posterior draws in each modeling step, reported at the 2.5% and 97.5% of the draws' distribution, while out-of-sample predictive validation was pursued for all the models. Results: The total burden associated with AMR in Croatia was 2546 (95% UI 1558-3803) deaths and 46958 (28,033-71,628) DALYs, while the attributable burden was 614 (365-943) deaths and 11321 (6,544-17,809) DALYs. The highest number of deaths was established for bloodstream infections, followed by peritoneal and intra-abdominal infections and infections of the urinary tract. Five leading pathogenic bacterial agents were responsible for 1808 deaths associated with resistance: Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa (ordered by the number of deaths). Trimethoprim/sulfamethoxazole-resistant E coli and methicillin-resistant S. aureus were dominant pathogen-drug combinations in regard to mortality associated with and attributable to AMR, respectively. Conclusion: We showed that AMR represented a substantial public health concern in Croatia, which reflects global trends; hence, our detailed country-level findings may fast-track the implementation of multipronged strategies tailored in accordance with leading pathogens and pathogen-drug combinations.
August 2023
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276 Reads
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19 Citations
The Lancet Regional Health - Americas
... Bacterial infections remain a significant global health concern, contributing to millions of illnesses and deaths annually [1]. Noteworthy pathogens include Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, and Listeria monocytogenes [2]. ...
September 2024
... Com a RAM, essas infecções se tornam mais difíceis de tratar, aumentando o risco de mortalidade, internações prolongadas e custos elevados para o sistema de saúde. Em nível econômico, a RAM é associada a além da promoção de boas práticas de higiene e saneamento (Naghavi et al., 2024). Contudo, a implementação de políticas eficazes enfrenta desafios, como a variabilidade das regulamentações e o uso indiscriminado de antimicrobianos na agricultura. ...
September 2024
... To reduce your chances of exposure to these bacteria, don't drink lake or pond water, wash your hands often, avoid unsecured foods, and beware of cross-contaminants between foods. [9]. Several studies have been conducted on contamination of well water with intestinal bacteria and sewage, especially the spread IOP Publishing doi:10.1088/1755-1315/1183/1/012068 ...
September 2024
... 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. ...
September 2024
The Lancet
... In 2019, an estimated 309 million disability-adjusted life-years (DALYs) were linked to 85 different parasites in children under the age of five, with Plasmodium spp., the causative agent of malaria, accounting for 12.0% of the total [186]. Another parasite, Toxoplasma gondii, is associated with various infections including congenital toxoplasmosis, which is transmitted from the mother to the foetus. ...
April 2024
The Lancet Infectious Diseases
... The presence of E. coli in drinking water indicates recent fecal contamination (WHO, 2023), and its antimicrobial resistance serves as a marker for the therapeutic and nontherapeutic use of antimicrobial drugs (Bennani et al., 2020). The emergence of antimicrobial resistance is a common phenomenon in areas where antimicrobials are extensively used (Popoola et al., 2024;Sartorius et al., 2024). Enteric bacteria in humans and livestock treated with antibiotics can develop resistance to these substances, with human and animal feces serving as direct sources of this resistance (Serwecińska, 2020;Nadeem et al., 2020). ...
February 2024
The Lancet Global Health
... Environmental antibiotic pollution creates a complex challenge due to the development of microbial antibiotic resistance from prolonged exposure in the environment [88]. Almost 5 million deaths were associated with antimicrobial resistance (AMR) in 2019, with AMR being directly responsible for 1.27 million deaths [89]. To effectively address this issue, the sorption of four antibiotics, namely chlortetracycline (CTC), oxytetracycline (OTC), ofloxacin (OFL), and enrofloxacin (ENR), on natural zeolite was investigated. ...
August 2023
Croatian Medical Journal
... Although challenges in LMICs are similar, they vary by country and can be addressed by strengthening AMS regulatory frameworks and surveillance systems. most severe impact of AMR is in low-and middle-income countries (LMICs) where weak health systems that are already overstretched are facing a double tragedy as once treatable conditions are proving difficult to treat [7][8][9]. The hope for a renaissance is placed on antimicrobial stewardship (AMS) programs as a strategy where collective efforts are geared toward appropriate use of antimicrobial agents [10][11][12][13][14][15]. ...
August 2023
The Lancet Regional Health - Americas
... It is estimated that by 2050, almost 10 million deaths will be caused by anti-microbial resistant (AMR) bacteria, making AMR a bigger global killer than cancer [18]. Africa is disproportionately affected by the rise in AMR due to insufficient environmental health practices, poor household and healthcare infrastructure, and misuse and overuse of antibiotics, which all contribute to the transmission of AMR pathogens and a concomitant higher risk of mortality from common infections that are now resistant to standard treatments [19,20]. ...
August 2023
The Lancet Regional Health - Americas
... C entral nervous system (CNS) infections are among the most severe pathologies during pediatric age, presenting a high mortality rate and a significant incidence of long-term sequelae. [1][2][3] The precise incidence of endocrinologic sequelae in patients with meningoencephalitis contracted in pediatric age is not known 4 ; studies conducted on adult populations have shown hormonal deficiencies may remain occult in the acute phase of infection, manifesting in the long-term follow-up, even years after recovery from the infectious episode. 5,6 It is reported in the literature that the most severe forms with a suggestive symptomatic clinical manifestation at diagnosis are more frequently associated with long-term complications. 1 In pediatric patients, CNS infections can lead to potentially life-threatening endocrine sequelae, such as adrenal insufficiency, 5 and may negatively affect the production of other pituitary tropic hormones, causing developmental alterations (growth hormone deficiency), delayed puberty due to reduced gonadotropin production, or central hypothyroidism. ...
August 2023
The Lancet Neurology