The burden of bacterial antimicrobial resistance in the WHO European region in 2019: a cross-country systematic analysis
Open accessAbstract
BACKGROUND: Antimicrobial resistance (AMR) represents one of the most crucial threats to public health and modern health care. Previous studies have identified challenges with estimating the magnitude of the problem and its downstream effect on human health and mortality. To our knowledge, this study presents the most comprehensive set of regional and country-level estimates of AMR burden in the WHO European region to date. METHODS: We estimated deaths and disability-adjusted life-years attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen-drug combinations for the WHO European region and its countries in 2019. Our methodological approach consisted of five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths attributable to AMR (considering an alternative scenario where infections with resistant pathogens are replaced with susceptible ones) and deaths associated with AMR (considering an alternative scenario where drug-resistant infections would not occur at all). Data were solicited from a wide array of international stakeholders; these included research hospitals, surveillance networks, and infection databases maintained by private laboratories and medical technology companies. We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. FINDINGS: We estimated 541 000 deaths (95% UI 370 000-763 000) associated with bacterial AMR and 133 000 deaths (90 100-188 000) attributable to bacterial AMR in the whole WHO European region in 2019. The largest fatal burden of AMR in the region came from bloodstream infections, with 195 000 deaths (104 000-333 000) associated with resistance, followed by intra-abdominal infections (127 000 deaths [81 900-185 000]) and respiratory infections (120 000 deaths [94 500-154 000]). Seven leading pathogens were responsible for about 457 000 deaths associated with resistance in 53 countries of this region; these pathogens were, in descending order of mortality, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecium, Streptococcus pneumoniae, and Acinetobacter baumannii. Methicillin-resistant S aureus was shown to be the leading pathogen-drug combination in 27 countries for deaths attributable to AMR, while aminopenicillin-resistant E coli predominated in 47 countries for deaths associated with AMR. INTERPRETATION: The high levels of resistance for several important bacterial pathogens and pathogen-drug combinations, together with the high mortality rates associated with these pathogens, show that AMR is a serious threat to public health in the WHO European region. Our regional and cross-country analyses open the door for strategies that can be tailored to leading pathogen-drug combinations and the available resources in a specific location. These results underscore that the most effective way to tackle AMR in this region will require targeted efforts and investments in conjunction with continuous outcome-based research endeavours. 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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The scarce data in some countries substantially affected the prevalence of resistance and relative risk modelling components.
“The scarce data in some countries substantially affected our prevalence of resistance and relative risk modelling components, akin to the situation in our previous publications.6, 50, 51, 60”
From Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 (2024) · cites this paper as [50]
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Reconstructing the Antibiotic Pipeline: Natural Alternatives to Antibacterial Agents
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New Agents Are Coming, and So Is the Resistance
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Predicting Antimicrobial Class Specificity of Small Molecules Using Machine Learning
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- Authors
- Mestrovic, T., Robles Aguilar, G., Swetschinski, L. R., Ikuta, K. S., Gray, A. P., Davis Weaver, N., Han, C., Wool, E. E., Gershberg Hayoon, A., Hay, S. I., Dolecek, C., Sartorius, B., Murray, C. J. L., Addo, I. Y., Ahinkorah, B. O., Ahmed, A., Aldeyab, M. A., Allel, K., Ancuceanu, R., Anyasodor, A. E., Ausloos, M., Barra, F., Bhagavathula, A. S., Bhandari, D., Bhaskar, S., Cruz-Martins, N., Dastiridou, A., Dokova, K., Dubljanin, E., Durojaiye, O. C., Fagbamigbe, A. F., Ferrero, S., Gaal, P. A., Gupta, V. B., Gupta, V. K., Gupta, V. K., Herteliu, C., Hussain, S., Ilic, I. M., Ilic, M. D., Jamshidi, E., Joo, T., Karch, A., Kisa, A., Kisa, S., Kostyanev, T., Kyu, H. H., Lám, J., Lopes, G., Mathioudakis, A. G., Mentis, A.-F. A., Michalek, I. M., Moni, M. A., Moore, C. E., Mulita, F., Negoi, I., Negoi, R. I., Palicz, T., Pana, A., Perdigão, J., Petcu, I.-R., Rabiee, N., Rawaf, D. L., Rawaf, S., Shakhmardanov, M. Z., Sheikh, A., Silva, L. M. L. R., Skryabin, V. Y., Skryabina, A. A., Socea, B., Stergachis, A., Stoeva, T. Z., Sumi, C. D., Thiyagarajan, A., Tovani-Palone, M. R., Yesiltepe, M., Zaman, S. B., & Naghavi, M.
- Affiliations
- University of Washington (US)
- Corresponding author
- Naghavi, Mohsen
- ORCID
- Ikuta, Kevin S
- Wool, Eve E
- Hay, Simon I
- Dolecek, Christiane
- Sartorius, Benn
- Murray, Christopher J L
- Addo, Isaac Yeboah
- Ahinkorah, Bright Opoku
- Ahmed, Ayman
- Aldeyab, Mamoon A
- Allel, Kasim
- Ancuceanu, Robert
- Anyasodor, Anayochukwu Edward
- Ausloos, Marcel
- Barra, Fabio
- Bhagavathula, Akshaya Srikanth
- Bhandari, Dinesh
- Bhaskar, Sonu
- Dokova, Klara
- Dubljanin, Eleonora
- Durojaiye, Oyewole Christopher
- Fagbamigbe, Adeniyi Francis
- Ferrero, Simone
- Gupta, Veer Bala
- Gupta, Vijai Kumar
- Gupta, Vivek Kumar
- Hussain, Salman
- Jamshidi, Elham
- Karch, André
- Kostyanev, Tomislav
- Kyu, Hmwe Hmwe
- Lopes, Graciliana
- Mathioudakis, Alexander G
- Mentis, Alexios-Fotios A
- Moni, Mohammad Ali
- Moore, Catrin E
- Mulita, Francesk
- Negoi, Ruxandra Irina
- Perdigão, João
- Petcu, Ionela-Roxana
- Rabiee, Navid
- Rawaf, David Laith
- Rawaf, Salman
- Shakhmardanov, Murad Ziyaudinovich
- Sheikh, Aziz
- Skryabin, Valentin Yurievich
- Skryabina, Anna Aleksandrovna
- Stergachis, Andy
- Sumi, Chandra Datta
- Thiyagarajan, Arulmani
- Zaman, Sojib Bin
- Naghavi, Mohsen
- Venue
- The Lancet Public Health
- Publisher
- Elsevier BV
- Published
- 2022-11
- Volume
- 7
- Issue
- 11
- Pages
- e897-e913
- ISSN
- 2468-2667 (ISSN-L)
- PMC
- PMC9630253
- OpenAlex
- W4306175007
- Cited by
- 384
- References
- 24
- Citations by year
- 2026: 87 · 2025: 91 · 2024: 112 · 2023: 86 · 2022: 8
- FWCI
- 48.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Huddersfield Research Portal (University of Huddersfield) (publishedVersion, cc-by)
- edoc (University of Basel) (acceptedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- Charles Sturt University Research Output (CRO) (submittedVersion, cc-by)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- St Andrews Research Repository (St Andrews Research Repository) (submittedVersion, cc-by)
- edoc (University of Basel)
- Funders
- Bill and Melinda Gates Foundation (OPP1176062)
- Wellcome Trust (A126042)
- Manchester Biomedical Research Centre
- National Authority for Scientific Research and Innovation
- Autoritatea Natională pentru Cercetare Stiintifică (CEECIND/00394/2017, UID/DTP/04138/2019)
- Unitatea Executiva pentru Finantarea Invatamantului Superior, a Cercetarii, Dezvoltarii si Inovarii (PN-III-P4-ID-PCCF-2016-0084)
- National Health and Medical Research Council
- Fundação para a Ciência e a Tecnologia
- European Social Fund
- Ministerul Cercetării, Inovării şi Digitalizării (CZ.02.2.69/0.0/0.0/18_053/0016952, ID-585-CTR-42-PFE-2021)
- National Institute for Health and Care Research
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
- Keywords
- antimicrobial resistance, bacterial infection, disease burden, mortality, disability-adjusted life years, bloodstream infection, intra-abdominal infection, respiratory infections, drug-resistant pathogens, counterfactual scenarios, WHO European Region, uncertainty intervals, infection duration, surveillance data, public health policy, health care costs, antimicrobial stewardship, infection control
- MeSH terms
- Anti-Bacterial Agents, Escherichia coli, Humans, World Health Organization, Drug Resistance, Bacterial, Methicillin-Resistant Staphylococcus aureus
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