Global burden of lower respiratory infections associated with antimicrobial resistance: insights from the Global Burden of Disease 2021

BACKGROUND: Lower respiratory infections (LRIs) remain a leading cause of death and disability. AMR is considered as a paramount twenty-first century public health threat. OBJECTIVES: To assess the global burden of AMR-associated LRIs using data from Global Burden of Disease (GBD) 2021. METHODS: Mortality data, including absolute counts, age-standardized mortality rates (ASMRs), and AMR-specific metrics, were extracted from the GBD 2021 dataset and stratified by demographic characteristics (age groups, sex), geographic regions, and socioeconomic status (SDI tiers). RESULTS: From 1990 to 2021, both absolute death counts and ASMRs demonstrated significant declines (EAPC: - 2.09); mortality burden (the death counts and ASMRs) caused by bacteria with AMR are 2 to 3 times that of bacteria with AMS; highest burden was observed in low-SDI regions and increasing trends were noted among older adults (≥ 50 years); S. pneumoniae dominated overall mortality, and S. aureus showed concerning upward trends; the mortality related to carbapenem-resistant A. Baumannii, E. coli, K. pneumoniae, and P. aeruginosa was on the rise. CONCLUSIONS: While overall burden of AMR-associated LRIs mortality shows a declining trajectory, significant disparities persist across SDI strata. The emergence of resistance to last-resort antimicrobials of the leading bacterial pathogens highlights the urgent need for the prevention and control of AMR.