Global burden of antimicrobial resistance in lower respiratory infections: a systematic analysis for the Global Burden of Disease Study 2021 - PubMed

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Global burden of antimicrobial resistance (AMR) in lower respiratory infections (LRIs) analyzed from 1990 to 2021.
In 2021, AMR was associated with 1.64 million global LRI deaths and directly attributable to 0.40 million deaths.
Age-standardized mortality rates (ASMRs) declined significantly from 1990 to 2021.
Substantial reductions in deaths among children under five, but rising deaths among adults ≥60 years.
Males exhibited a higher mortality burden than females, with variations by age group.
Sub-Saharan Africa had the highest regional burden of AMR in LRIs.
Six pathogens accounted for >92.1% of deaths, including Streptococcus pneumoniae and Klebsiella pneumoniae.
Resistance of S. pneumoniae to trimethoprim-sulfamethoxazole and macrolides contributed the most AMR-associated deaths globally.
β-lactam resistance was the leading cause of AMR-attributable deaths.
Urgent gaps identified in addressing Gram-negative resistance, geriatric burden, and disparities.
Equitable vaccine access, enhanced diagnostics, and targeted interventions are critical to mitigating AMR burden.

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