The prevalence and risk of mortality associated with antimicrobial resistance within nosocomial settings-a global systematic review and meta-analysis of over 20,000 patients

This systematic review and meta-analysis of 34 studies involving over 20,000 hospitalised patients found that antimicrobial resistance (AMR) is highly prevalent in hospitals worldwide (36.5%) and significantly increases the risk of in-hospital mortality (adjusted pooled risk ratio 1.58, 95% CI 1.33–1.87) compared with non-resistant infections. Most data originated from high- and middle-income countries (e.g. USA, China, UK, Japan), while no studies were identified from Africa, the Middle East, Russia, or India. The evidence suggests particularly elevated mortality risks for AMR-associated bacteraemia. Despite generally high study quality, publication bias and limited mechanistic modelling were noted, and the overall certainty of evidence for mortality was low. The findings highlight AMR as a major in-hospital threat, underscoring the urgent need for research and interventions in underrepresented regions to curb AMR transmission and reduce hospital mortality.