Elicit: Burden of AMR by Region (public)
Burden of AMR by Region (public)
What is the burden of disease for AMR by geographic region?
AMR caused 4.71M associated deaths globally in 2021, with regional distribution showing approximately 541,000 deaths in Europe, 569,000 in the Americas, and varying country-specific impacts.
Abstract
Antimicrobial resistance (AMR) exacts a heavy toll that varies by region. Global cross‐country studies report that in 2021 AMR was linked with 4.71 million deaths (range: 4.23–5.19 million) and 1.14 million deaths were directly attributable to resistance (range: 1.00–1.28 million); projections for 2050 reach 8.22 million associated and 1.91 million attributable deaths, with an estimated 46.5 million disability‐adjusted life years lost. In the WHO European region, estimates include 541,000 associated and 133,000 attributable deaths, while in the Americas figures of 569,000 associated and 141,000 attributable deaths have been documented. Country-specific data further detail the burden; for example, one study from Japan notes 14,300 deaths linked to MRSA and a study from China reports 711,852 associated deaths.
Key pathogens driving these outcomes include Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and Acinetobacter baumannii. Findings further indicate that gram-negative resistance is often shaped by carbapenem-resistant pathogens, whereas MRSA predominates the gram-positive burden. Economic and healthcare impacts have been quantified in several settings—for instance, incremental costs of US$2 billion for MRSA in Japan, increases in hospital stays ranging from 1.6 to over 8 additional days, and societal economic burdens reaching billions in local currencies. These studies collectively underscore a substantial and regionally variable disease burden due to AMR.
Methods
We analyzed 25 sources from an initial pool of 496, using 7 screening criteria. Each paper was reviewed for 5 key aspects that mattered most to the research question.
Results
Characteristics of Included Studies
| Study | Study Design | Geographic Coverage | Burden Metrics | Key Pathogens Studied |
|---|---|---|---|---|
| Naghavi et al., 2024 | Burden of disease, systematic, cross-country | 204 countries, global, GBD superregions | Deaths associated/attributable, DALYs | 22 pathogens, 84 combinations; Staphylococcus aureus, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, Pseudomonas aeruginosa |
| Uematsu et al., 2017 | Epidemiological, burden of disease | Japan (nationwide) | In-hospital mortality, costs, length of stay | Methicillin-resistant Staphylococcus aureus (MRSA) |
| Otieku et al., 2023 | Epidemiological, prospective cohort | Ghana (2 hospitals) | Mortality, length of stay, patient costs | Escherichia coli, Klebsiella species, MRSA |
| Li et al., 2022 | Burden of disease, cross-country, systematic | Global, 204 countries, 21 GBD regions | Deaths associated/attributable, DALYs, YLLs, YLDs | 14 pathogens, 66 combinations; Escherichia coli, Klebsiella pneumoniae |
| Meštrović et al., 2022 | Systematic, cross-country, burden of disease | WHO European region (53 countries) | Deaths associated/attributable | 23 pathogens, 88 combinations; Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecium, Streptococcus pneumoniae, Acinetobacter baumannii |
| Murray et al., 2022 | Systematic, burden of disease, cross-country | Global, 204 countries | Deaths associated/attributable | 23 pathogens, 88 combinations; Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa |
Global and Regional Disease Burden
Mortality Burden
| Study | Geographic Region | Annual Deaths (Associated/Attributable) | Leading Resistant Pathogens |
|---|---|---|---|
| Naghavi et al., 2024 | Global, 204 countries | 2021: 4.71 million (associated), 1.14 million (attributable) | Staphylococcus aureus, Acinetobacter baumannii, Escherichia coli |
| Uematsu et al., 2017 | Japan | 14,300 deaths (associated) | MRSA |
| Otieku et al., 2023 | Ghana | 15.4% mortality (antimicrobial resistance cohort) | Escherichia coli, Klebsiella species, MRSA |
| Li et al., 2022 | Global/regions | 2019: 0.26 million (associated), 64,890 (attributable) | Escherichia coli, Klebsiella pneumoniae |
| Meštrović et al., 2022 | WHO Europe | 541,000 (associated), 133,000 (attributable) | Escherichia coli, Staphylococcus aureus |
Economic and Healthcare Impact
Direct Healthcare Costs and Productivity Losses
| Study | Region | Healthcare Costs | Length of Stay | Productivity Impact |
|---|---|---|---|---|
| Naghavi et al., 2024 | Global | No mention found | No mention found | No mention found |
| Uematsu et al., 2017 | Japan | US$2 billion incremental MRSA cost | 4.34 million days (MRSA) | No mention found |
| Otieku et al., 2023 | Ghana | US$1–1.4 million annual patient cost | +5–8 days (antimicrobial resistance) | 30% of extra cost due to productivity loss |
| Li et al., 2022 | Global | No mention found | No mention found | No mention found |
Pathogen-Specific Regional Patterns
Gram-Negative Resistance Patterns
| Study | Region | Gram-Negative Pathogens | Resistance Types | Mortality/DALY Impact |
|---|---|---|---|---|
| Naghavi et al., 2024 | Global | Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa | Carbapenem resistance | High mortality, rising trend |
References
- Xu-Hui Li et al., 2022. Global and Regional Burden of Bacterial Antimicrobial Resistance in Urinary Tract Infections in 2019. Journal of Clinical Medicine
- T. Meštrović et al., 2022. The burden of bacterial antimicrobial resistance in the WHO European region in 2019: a cross-country systematic analysis. Lancet Public Health
- G. Aguilar et al., 2023. The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis. The Lancet Regional Health - Americas
- M. Naghavi et al., 2024. Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. The Lancet
- K. Lewandrowski et al., 2024. Disability-adjusted life years from bone and joint infections associated with antimicrobial resistance: an insight from the 2019 Global Burden of Disease Study. International Orthopaedics
Note: This report synthesizes key findings on the burden of antimicrobial resistance (AMR) by region, including mortality, economic impact, and pathogens involved.