Wan Xingyu, Miao Run, Zhang Ning, Huang Wei, Wu Zhengyang, Wang Haiwei, Yang Yang, Xie Yinyin, Du Yinan
School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, China; Second School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China.
Second School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China.
Int J Antimicrob Agents. 2025 Feb;65(2):107431. doi: 10.1016/j.ijantimicag.2024.107431. Epub 2024 Dec 27.
The research aimed to provide a worldwide evaluation of antimicrobial resistance (AMR), focusing specifically on AMR related to lower respiratory infections (LRI).
The data were derived from the Global Antimicrobial Resistance Burden 2021 (GARB 2021). Two counterfactuals were utilized to estimate the deaths attributable to AMR and the deaths associated with AMR. The primary estimation process involved various statistical methodologies, including polynomial estimation and ensemble spatiotemporal Gaussian regression models. Using the DisMod-MR 2.1 modeling framework, the incidence and prevalence of LRI were estimated, the mortality rates were subsequently calculated, and stratified by pathogens, regions, and age groups. In addition, these indexes were identified and visualized to present global burden of AMR.
In 2021, there were 20.89 (95% uncertain interval: 18.27-23.50) deaths per 100 000 individuals associated with AMR in LRI, and 5.05 (95% UI: 4.29-5.51) deaths per 100 000 individuals attributable to AMR in LRI. Trimethoprim-sulfamethoxazole-resistant S. pneumoniae exhibited the highest mortality rate of 5.15 (95% UI: 3.96- 6.34) deaths per 100 000 individuals associated with AMR, while Carbapenem -resistant S. pneumoniae exhibited the highest mortality rate of 0.66 (95% UI: 0.45-0.86) deaths per 100 000 individuals attributable to AMR. S. pneumoniae exhibited the greatest burden of AMR, followed by S. aureus. Central Sub-Saharan Africa had the highest AMR burden, with mortality rates of 73.75 (95% UI: 56.61-90.89) deaths per 100 000 individuals associated with AMR and 17.73 (95% UI: 12.71-2.74) deaths per 100 000 individuals attributable to AMR, followed by Eastern Sub-Saharan Africa and Western Sub-Saharan Africa. The individuals aged under 5 and over 65 years exhibited high prevalence of antibiotic resistance especially to Carbapenems, Methicillin, and Fluoroquinolones.
AMR in the LRI is still a pressing global health issue, particularly in developing countries and neonatal age groups. Global interventions need to be taken to reduce the prevalence of AMR.
本研究旨在对全球抗菌药物耐药性（AMR）进行评估，特别关注与下呼吸道感染（LRI）相关的AMR。
数据来源于《2021年全球抗菌药物耐药负担》（GARB 2021）。采用两种反事实方法来估计AMR归因死亡数和与AMR相关的死亡数。主要估计过程涉及多种统计方法，包括多项式估计和时空高斯回归模型集成。使用DisMod-MR 2.1建模框架，估计LRI的发病率和患病率，随后计算死亡率，并按病原体、地区和年龄组进行分层。此外，还确定并可视化了这些指标，以呈现AMR的全球负担。
2021年，每10万人中与LRI中AMR相关的死亡数为20.89（95%不确定区间：18.27 - 23.50），LRI中AMR归因的死亡数为每10万人5.05（95%不确定区间：4.29 - 5.51）。耐甲氧苄啶 - 磺胺甲恶唑的肺炎链球菌与AMR相关的死亡率最高，为每10万人5.15（95%不确定区间：3.96 - 6.34），而耐碳青霉烯类的肺炎链球菌AMR归因死亡率最高，为每10万人0.66（95%不确定区间：0.45 - 0.86）。肺炎链球菌的AMR负担最大，其次是金黄色葡萄球菌。撒哈拉以南非洲中部的AMR负担最高，每10万人中与AMR相关的死亡率为73.75（95%不确定区间：56.61 - 90.89），AMR归因的死亡率为每10万人17.73（95%不确定区间：12.71 - 22.74），其次是撒哈拉以南非洲东部和撒哈拉以南非洲西部。5岁以下和65岁以上人群对抗生素的耐药性普遍较高，尤其是对碳青霉烯类、甲氧西林和氟喹诺酮类。
LRI中的AMR仍然是一个紧迫的全球卫生问题，特别是在发展中国家和新生儿年龄组。需要采取全球干预措施来降低AMR的患病率。
