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

作者：Benn Sartorius, Authia P Gray, Nicole Davis Weaver, Gisela Robles Aguilar, Lucien R Swetschinski, Kevin S Ikuta, Tomislav Meštrović, Erin Chung, Eve E Wool, Chieh Han, Anna Gershberg Hayoon, Daniel T Araki, Sherief Abd‐Elsalam, Richard Gyan Aboagye, Lawan Hassan Adamu, Victor Abiola Adepoju, Ayman Ahmed, Gizachew Taddesse Akalu, Wuraola Akande‐Sholabi, John Amuasi, Ganiyu Adeniyi Amusa, Ayele Mamo Argaw, Raphael Taiwo Aruleba, Tewachew Awoke, Melese Kitu Ayalew, Ahmed Y. Azzam, François-Xavier Babin, Indrajit Banerjee, Afisu Basiru, Nebiyou Simegnew Bayileyegn, Melaku Ashagrie Belete, James A. Berkley, Julia Bielicki, Denise Dekker, Dessalegn Demeke, Desalegn Getnet Demsie, Anteneh Mengist Dessie, Susanna Dunachie, Abdelaziz Ed‐Dra, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Iman El Sayed, Muhammed Elhadi, Ibrahim Elsohaby, David W. Eyre, Adeniyi Francis Fagbamigbe, Nicholas Feasey, Ginenus Fekadu, Frederick Fell, Karen Forrest, Mesfin Gebrehiwot, Kebede Embaye Gezae, Ramy Mohamed Ghazy, Tewodros Tesfa Hailegiyorgis, Georgina Haines–Woodhouse, Ahmed I Hasaballah, Andrea Haselbeck, Yingfen Hsia, Arnaud Iradukunda, Kenneth Iregbu, Chidozie C D Iwu, Chinwe Juliana Iwu, Assefa N Iyasu, Fatoumatta Jaiteh, Hyonjin Jeon, Charity Ehimwenma Joshua, Gebrehiwot G Kassa, Patrick DMC Katoto, Ralf Krumkamp, Emmanuelle A. P. Kumaran, Hmwe Hmwe Kyu, Aseer Manilal, Florian Marks, Jürgen May, Susan A. McLaughlin, Barney McManigal, Addisu Melese, Kebede Haile Misgina, Nouh Saad Mohamed, Mustapha Mohammed, Shafiu Mohammed, Shikur Mohammed, Ali H. Mokdad, Catrin E. Moore, Vincent Mougin, Neema Mturi, Temesgen Mulugeta, Fungai Musaigwa, Patrick Musicha, Lillian Musila, Muthupandian Saravanan, Pirouz Naghavi, Hadush Negash, Dooshanveer C Nuckchady, Christina W. Obiero, Ismail Ayoade Odetokun, Oluwaseun Adeolu Ogundijo, Lawrence Okidi, Osaretin Christabel Okonji, Andrew T Olagunju, Isaac Iyinoluwa Olufadewa, Gi Deok Pak, Olga Perovic, Andrew J. Pollard, Mathieu Raad, Clotaire Donatien Rafaï, Hazem Ramadan, Elrashdy M. Redwan, Anna Roca, Víctor Rosenthal, Mohamed A. Saleh, Abdallah M Samy, Mike Sharland, Aminu Shittu, Emmanuel Edwar Siddig, Eskinder Ayalew Sisay, Andy Stergachis, Wegen Beyene Tesfamariam, Caroline Tigoi, Marius B. Tincho, Tenaw Yimer Tiruye, Chukwuma David Umeokonkwo, Timothy R. Walsh, Judd L. Walson, Hadiza Yusuf, Naod Gebrekrstos Zeru, Simon I Hay, Christiane Dolecek, Christopher J L Murray, Mohsen Naghavi · 发表于：The Lancet Global Health · 年份：2023 · DOI：10.1016/s2214-109x(23)00539-9 · 被引用次数：334 · 研究领域：Antibiotic Use and Resistance、Antibiotic Resistance in Bacteria、Urinary Tract Infections Management

BACKGROUND: A critical and persistent challenge to global health and modern health care is the threat of antimicrobial resistance (AMR). Previous studies have reported a disproportionate burden of AMR in low-income and middle-income countries, but there remains an urgent need for more in-depth analyses across Africa. This study presents one of the most comprehensive sets of regional and country-level estimates of bacterial AMR burden in the WHO African region to date. METHODS: We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen-drug combinations for countries in the WHO African region 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 ...