Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050

Antimicrobial resistance (AMR) is a significant global health issue, with no comprehensive estimates of its burden across locations. A study from 1990 to 2021 estimated all-age and age-specific deaths and disability-adjusted life-years associated with bacterial AMR for 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes in 204 countries and territories. The study used various data sources, including 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. The study also produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario, a Gram-negative drug scenario, and a better care scenario.

In 2021, an estimated 4·71 million deaths were associated with bacterial AMR, with 1·14 million deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years but increased by over 80% for adults 70 years and older. Resistance to carbapenems increased more than any other antibiotic class among Gram-negative bacteria. The study predicts that an estimated 1·91 million deaths attributable to AMR and 8·22 million deaths associated with AMR could occur globally in 2050. The highest all-age AMR mortality rate in 2050 is forecasted to be in south Asia, Latin America, and the Caribbean. The study emphasizes the importance of infection prevention, vaccination, minimization of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the global AMR death burden.