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Cited by 2,235Antibiotic Use and ResistanceGlobal Health and EpidemiologyPneumonia and Respiratory Infections

Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019

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Ikuta, Kevin S, Swetschinski, Lucien R, Robles Aguilar, Gisela, Sharara, Fablina, Mestrovic, Tomislav, Gray, Authia P, Davis Weaver, Nicole, Wool, Eve E +557 more·2022·The Lancet
DOI 10.1016/s0140-6736(22)02185-7PMC PMC9763654
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Abstract

BACKGROUND: Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. METHODS: We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. FINDINGS: From an estimated 13·7 million (95% UI 10·9-17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7-10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2-18·1) of all global deaths and 56·2% (52·1-60·1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54·9% (52·9-56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4-71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. INTERPRETATION: The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. FUNDING: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund.

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  • In 2019, 4.95 million deaths were associated with bacterial AMR.

    “4·95 million deaths were associated with AMR.6, 7”

    From Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 (2024) · cites this paper as [7]

    The Results report 7·7 million deaths associated with 33 bacterial pathogens in 2019, including infections both resistant and susceptible to antimicrobials. The Discussion distinguishes this study’s estimate from an earlier study of antimicrobial resistance. Searches for 4·95 million and deaths associated with resistance found no passage in our copy stating the claimed AMR figure. (LLM, conf=0.77)

    Experimental — accuracy not yet measured

  • In 2019, 1.27 million deaths were attributable to bacterial AMR.

    “1·27 million deaths were attributable to AMR”

    From Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 (2024) · cites this paper as [7]

    The Results report 7·7 million deaths associated with 33 bacterial pathogens in 2019, including both antimicrobial-susceptible and resistant infections. The Discussion says a previous study examined resistance, but our copy does not state that 1·27 million deaths were attributable to AMR; searches for that number and for AMR-attributable deaths found no supporting passage. No page numbers were available in the indexed passages. (LLM, conf=0.76)

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  1. [23]Nocedal J Wright SJ Numerical optimization, second edition 2006 Springer-Verlag New York, NY
  2. [40]Araya P Hug J Joy G Oschmann F Rubinstein S The impact of water and sanitation on diarrhoeal disease burden and over-consumption of antibiotics. London School of Economics and Political Science, March, 2016 https://amr-review.org/sites/default/files/LSE%20AMR%20Capstone.pdf

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Ikuta, K. S., Swetschinski, L. R., Robles Aguilar, G., Sharara, F., Mestrovic, T., Gray, A. P., Davis Weaver, N., Wool, E. E., Han, C., Gershberg Hayoon, A., Aali, A., Abate, S. M., Abbasi-Kangevari, M., Abbasi-Kangevari, Z., Abd-Elsalam, S., Abebe, G., Abedi, A., Abhari, A. P., Abidi, H., Aboagye, R. G., Absalan, A., Abubaker Ali, H., Acuna, J. M., Adane, T. D., Addo, I. Y., Adegboye, O. A., Adnan, M., Adnani, Q. E. S., Afzal, M. S., Afzal, S., Aghdam, Z. B., Ahinkorah, B. O., Ahmad, A., Ahmad, A. R., Ahmad, R., Ahmad, S., Ahmad, S., Ahmadi, S., Ahmed, A., Ahmed, H., Ahmed, J. Q., Ahmed Rashid, T., Ajami, M., Aji, B., Akbarzadeh-Khiavi, M., Akunna, C. J., Al Hamad, H., Alahdab, F., Al-Aly, Z., Aldeyab, M. A., Aleman, A. V., Alhalaiqa, F. A. N., Alhassan, R. K., Ali, B. A., Ali, L., Ali, S. S., Alimohamadi, Y., Alipour, V., Alizadeh, A., Aljunid, S. M., Allel, K., Almustanyir, S., Ameyaw, E. K., Amit, A. M. L., Anandavelane, N., Ancuceanu, R., Andrei, C. L., Andrei, T., Anggraini, D., Ansar, A., Anyasodor, A. E., Arabloo, J., Aravkin, A. Y., Areda, D., Aripov, T., Artamonov, A. A., Arulappan, J., Aruleba, R. T., Asaduzzaman, M., Ashraf, T., Athari, S. S., Atlaw, D., Attia, S., Ausloos, M., Awoke, T., Ayala Quintanilla, B. P., Ayana, T. M., Azadnajafabad, S., Azari Jafari, A., B, D. B., Badar, M., Badiye, A. D., Baghcheghi, N., Bagherieh, S., Baig, A. A., Banerjee, I., Barac, A., Bardhan, M., Barone-Adesi, F., Barqawi, H. J., Barrow, A., Baskaran, P., Basu, S., Batiha, A.-M. M., Bedi, N., Belete, M. A., Belgaumi, U. I., Bender, R. G., Bhandari, B., Bhandari, D., Bhardwaj, P., Bhaskar, S., Bhattacharyya, K., Bhattarai, S., Bitaraf, S., Buonsenso, D., Butt, Z. A., Caetano dos Santos, F. L., Cai, J., Calina, D., Camargos, P., Cámera, L. A., Cárdenas, R., Cevik, M., Chadwick, J., Charan, J., Chaurasia, A., Ching, P. R., Choudhari, S. G., Chowdhury, E. K., Chowdhury, F. R., Chu, D.-T., Chukwu, I. S., Dadras, O., Dagnaw, F. 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R., Van den Eynde, J., van Doorn, H. R., Vaziri, S., Verras, G.-I., Viswanathan, H., Vo, B., Waris, A., Wassie, G. T., Wickramasinghe, N. D., Yaghoubi, S., Yahya, G. A. T. Y., Yahyazadeh Jabbari, S. H., Yigit, A., Yiğit, V., Yon, D. K., Yonemoto, N., Zahir, M., Zaman, B. A., Zaman, S. B., Zangiabadian, M., Zare, I., Zastrozhin, M. S., Zhang, Z.-J., Zheng, P., Zhong, C., Zoladl, M., Zumla, A., Hay, S. I., Dolecek, C., Sartorius, B., Murray, C. J. L., & Naghavi, M.
Affiliations
University of Washington (US)
Corresponding author
Naghavi, Mohsen
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2022-12
Volume
400
Issue
10369
Pages
2221-2248
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(22)02185-7
PMC
PMC9763654
OpenAlex
W4309503005
Cited by
2,235
References
37
Citations by year
2026: 517 · 2025: 730 · 2024: 654 · 2023: 325 · 2022: 8 · 2013: 1
FWCI
278.44
Type
journal article
Language
en
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  • Shiraz University
  • Universitair Medisch Centrum Groningen
  • Kermanshah University of Medical Sciences
  • Universitetet i Oslo
  • Tehran Heart Center
  • Guilan University of Medical Sciences
  • Universidade de São Paulo
  • Università degli Studi del Piemonte Orientale
  • Universidad Nacional Autónoma de México
  • Università Cattolica del Sacro Cuore
  • Shahrekord University of Medical Sciences
  • Göteborgs Universitet
  • Autoritatea Natională pentru Cercetare Stiintifică
  • Shahid Beheshti University of Medical Sciences
  • Bahir Dar University
  • Università di Bologna
  • Ateneo de Manila University
  • United Arab Emirates University
  • Universidad de la República Uruguay
  • Ministério da Ciência, Tecnologia e Ensino Superior (UID/Multi/50016/2019)
  • Oulun Yliopisto
  • Centre Hospitalier Universitaire Vaudois
  • Qazvin University of Medical Sciences
  • Yarmouk University (34/2017)
  • Aristotle University of Thessaloniki
  • Unitatea Executiva pentru Finantarea Invatamantului Superior, a Cercetarii, Dezvoltarii si Inovarii (34/2017, PN-III-P4-ID, PN-III-P4-ID-PCCF-2016-0084, PN-III-P4-ID-PCCF-2016)
  • Federation University Australia
  • Technische Universität Berlin
  • Wuhan University
  • Secretaría Nacional de Ciencia, Tecnología e Innovación
  • University of Cape Town
  • Yasuj University of Medical Sciences
  • Urmia University
  • Binzhou Medical University
  • Universitatea din București
  • Universidade Federal de Minas Gerais
  • University of the Philippines
  • Shaqra University
  • Majmaah University
  • Universitatea de Medicină şi Farmacie "Carol Davila" Bucureşti
  • University of Tabriz
  • Ilam University
  • University of Gondar
  • Addis Ababa University
  • Tanta University
  • National Nutrition and Food Technology Research Institute
  • Golestan University of Medical Sciences
  • Zanjan University of Medical Sciences
  • Dire Dawa University
  • Khulna University
  • University of Zanjan
  • Xiamen University
  • University of Peradeniya
  • International Centre for Diarrhoeal Disease Research, Bangladesh
  • Mansoura University
  • International Medical University
  • Mekelle University
  • National Center of Neurology and Psychiatry
  • Jawaharlal Institute Of Postgraduate Medical Education and Research
  • University of Colombo
  • University of Thessaly
  • Masarykova Univerzita (MUNI/IGA/1104/2021, LX22NPO5101)
  • Monash University Malaysia
  • Rajarata University of Sri Lanka
  • King Fahad Medical City
  • Gonabad University of Medical Sciences
  • Lorestan University of Medical Sciences
  • Hellenic Foundation for Research and Innovation (MIMS-860)
  • Hubei University of Medicine
  • Lingnan University
  • Imam Abdulrahman Bin Faisal University
  • Universiti Sultan Zainal Abidin
  • Jenderal Soedirman University
  • Jahrom University of Medical Sciences
  • University of Tlemcen
  • Universitas Padjadjaran
  • Universitas Syiah Kuala
  • Rajshahi University
  • Universitatea Sapientia
  • Universidad Autónoma de Sinaloa
  • Moscow Institute of Physics and Technology
  • Alfaisal University
  • Pirogov Russian National Research Medical University
  • Ajman University
  • Humanitas Research Hospital
  • National Institute of Pharmaceutical Education and Research, Raebareli
  • Madda Walabu University
  • Dilla University
  • Adigrat University
  • University of Health and Allied Sciences
  • Debre Tabor University
  • University of Veterinary and Animal Sciences
  • Uniwersytet Opolski
  • National Institutes of Health (COVID-19)
  • Directorate for Biological Sciences
  • Defense Threat Reduction Agency
  • Samsung
  • Horizon 2020 Framework Programme (LX22NPO5101)
  • Medical Research Council (MR/W020653/1, MR/W02067X/1, COVID-19)
  • National Health and Medical Research Council
  • Leibniz-Gemeinschaft
  • Japan Society for the Promotion of Science (21K04541)
  • Fundação para a Ciência e a Tecnologia (CEN-TRO-04-3559-FSE-000162, UID/Multi/50016/2019, /2017)
  • Russian Academy of Sciences
  • Gastrointestinal and Liver Diseases Research Center
  • Yonsei University College of Medicine
  • European Regional Development Fund (CENTRO-04-3559-FSE-000162)
  • Center for International Health
  • Zabol University of Medical Sciences
  • National Research, Development and Innovation Office (RRF-2.3.1-21, RRF-2.3.1-21-2022-00006)
  • NIHR Sheffield Biomedical Research Centre
  • National Heart, Lung, and Blood Institute
  • National Human Genome Research Institute
  • National Institute of General Medical Sciences (K23GM141463)
  • National Institute of Allergy and Infectious Diseases (T32AI007044)
  • Fogarty International Center (D43TW009763)
  • NIH Clinical Center
  • Division of Human Resource Development
  • Janssen Pharmaceuticals
  • European and Developing Countries Clinical Trials Partnership (CANTAM-3)
Topics
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
Keywords
pathogenic bacteria, infectious disease mortality, antimicrobial resistance, sepsis, infectious syndromes, attributable fraction, mortality estimates, Global Burden of Disease Study 2019, sex differences in mortality, age differences in mortality, uncertainty intervals
MeSH terms
Global Burden of Disease, Bacteria, Bacterial Infections, Child, Female, Humans, Male, Risk Factors, Syndrome, Global Health, Africa South of the Sahara, Sepsis

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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