The burden of bacterial antimicrobial resistance in the WHO European region in 2019: a cross-country systematic analysis

作者：Tomislav Meštrović, Gisela Robles Aguilar, Lucien R Swetschinski, Kevin S Ikuta, Authia P Gray, Nicole Davis Weaver, Chieh Han, Eve E Wool, Anna Gershberg Hayoon, Simon I Hay, Christiane Dolecek, Benn Sartorius, Christopher J L Murray, Isaac Yeboah Addo, Bright Opoku Ahinkorah, Ayman Ahmed, Mamoon A. Aldeyab, Kasim Allel, Robert Ancuceanu, Anayochukwu Edward Anyasodor, Marcel Ausloos, Fabio Barra, Akshaya Srikanth Bhagavathula, Dinesh Bhandari, Sonu Bhaskar, Natália Martins, Anna Dastiridou, Клара Докова, Eleonora Dubljanin, Oyewole Christopher Durojaiye, Adeniyi Francis Fagbamigbe, Simone Ferrero, Péter Gaál, Veer Bala Gupta, Vijai Kumar Gupta, Vivek Gupta, Claudiu Herţeliu, Salman Hussain, Irena Ilić, Milena Ilić, Elham Jamshidi, Tamás Joó, André Karch, Adnan Kısa, Sezer Kısa, Tomislav Kostyanev, Hmwe Hmwe Kyu, Judit Lám, Graciliana Lopes, Alexander G. Mathioudakis, Alexios‐Fotios A. Mentis, Irmina Maria Michałek, Mohammad Ali Moni, Catrin E. Moore, Francesk Mulita, Ionuţ Negoi, Ruxandra Irina Negoi, Tamás Palicz, Adrian Pană, João Perdigão, Ionela-Roxana Petcu, Navid Rabiee, David Laith Rawaf, Salman Rawaf, Murad Z. Shakhmardanov, Aziz Sheikh, Luís R. Silva, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Bogdan Socea, Andy Stergachis, Temenuga Stoeva, Chandra Datta Sumi, Arulmani Thiyagarajan, Marcos Roberto Tovani‐Palone, Metin Yeşiltepe, Sojib Bin Zaman, Mohsen Naghavi · 发表于：The Lancet Public Health · 年份：2022 · DOI：10.1016/s2468-2667(22)00225-0 · 被引用次数：368 · 研究领域：Antibiotic Use and Resistance、Antibiotic Resistance in Bacteria、Zoonotic diseases and public health

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 w...