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.

Screening

We screened in sources based on their abstracts that met these criteria:

• Burden Metrics: Does the study report at least one AMR burden metric (mortality, morbidity, healthcare costs, length of hospital stay, or disability-adjusted life years)?
• Study Population: Does the study examine human populations in any healthcare setting (community, hospital, or long-term care)?
• Geographic Context: Does the study specify a clear geographic region or country where the research was conducted?
• Study Design: Is the study a primary research study, systematic review, or meta-analysis containing empirical data?
• Pathogen Focus: Does the study report on bacterial pathogen(s) with antimicrobial resistance?
• Outcome Specificity: Does the study report specific burden outcomes beyond just prevalence or resistance mechanisms?
• Sample Size: Does the study include 10 or more cases/participants?

Data extraction

We asked a large language model to extract each data column below from each paper.

• Study Design: Identify the specific type of study design used:

  • Systematic analysis
  • Cross-country analysis
  • Epidemiological study
  • Burden of disease study

• Geographic Scope: Record the specific geographic regions or countries included in the analysis:

  • Total number of countries/territories studied
  • Specific regions or countries named
  • Any stratification by region (e.g., WHO regions)

• Antimicrobial Resistance (AMR) Burden Metrics: Extract the specific AMR burden metrics used in the study:

  • Deaths associated with AMR
  • Deaths attributable to AMR
  • Disability-adjusted life years (DALYs)
  • Years of life lost (YLLs)
  • Years lived with disability (YLDs)

• Pathogens and Drug Resistance: List the key pathogens and drug resistance combinations studied:

  • Number of bacterial pathogens examined
  • Number of pathogen-drug combinations
  • Top pathogens by mortality
  • Most significant drug resistance types

• Time Period of Analysis: Record the specific time periods covered in the study:

  • Historical data collection period
  • Year of primary analysis
  • Future projection period (if applicable)

Results

Characteristics of Included Studies

Study Design

• Systematic, cross-country, or meta-analytic designs:16 studies.
• Epidemiological designs (including prospective cohort and case-control):15 studies.
• Overlap:Several studies used both systematic and epidemiological approaches.

Geographic Coverage

• Global coverage:7 studies.
• Europe or European countries:7 studies.
• Asia:8 studies (Japan: 3, China: 2, Thailand: 2, 1 with Asia focus).
• Africa:2 studies (Ghana and Uganda).
• Americas:3 studies (Americas region, Canada, United States).

Burden Metrics

• Deaths associated or attributable to antimicrobial resistance:14 studies.
• Disability-Adjusted Life Years (DALYs):6 studies.
• Years of Life Lost (YLLs):5 studies.
• Years Lived with Disability (YLDs):2 studies.
• Mortality (in-hospital or general):2 studies.
• Costs and length of stay:Each reported in 2 studies.
• No mention found for burden metrics:7 studies.
• Multiple metrics:Some studies reported more than one metric.

Key Pathogens Studied

• More than 10 pathogens or combinations:9 studies.
• Escherichia coli:12 studies.
• Staphylococcus aureus:9 studies.
• Klebsiella pneumoniae:9 studies.
• MRSA:8 studies.
• Acinetobacter baumannii:7 studies.
• Streptococcus pneumoniae:6 studies.
• Pseudomonas aeruginosa:8 studies.
• Other pathogens:Each included in 1 study.

Mortality Burden

Economic and Healthcare Impact

Direct Healthcare Costs and Productivity Losses

Pathogen-Specific Regional Patterns

Gram-Negative Resistance Patterns

Gram-Positive Resistance Patterns

References

1. Global burden of bacterial antimicrobial resistance 1990–2021
2. The burden of bacterial antimicrobial resistance in the WHO European region in 2019
3. The burden of antimicrobial resistance in the Americas in 2019
4. Global burden of bacterial antimicrobial resistance in 2019