Burden of bacterial antimicrobial resistance 1990–2021 in China: a systematic analysis for the global burden of disease study 2021

China faces a heavy burden from antimicrobial resistance (AMR). Using data from the Global Antimicrobial Resistance Burden study (1990–2021), researchers modeled AMR-related deaths and disability-adjusted life-years (DALYs).

• Scale of burden (2021): ~712,000 deaths were associated with bacterial AMR, including ~160,000 directly attributable deaths.

• Age trends: Deaths in children under 5 fell by 95% since 1990, while deaths among those ≥65 years rose by 68%.

• Infectious syndromes: Bloodstream infections, lower respiratory tract infections, and intra-abdominal infections accounted for the highest AMR-attributed deaths, with bloodstream infections rising most sharply.

• Pathogens: Staphylococcus aureus caused the most AMR-attributable deaths (≈40,000), particularly methicillin-resistant S. aureus (MRSA, ≈26,000). The fastest-growing burden came from third-generation cephalosporin-resistant Acinetobacter baumannii (+17.5% annually).

Conclusion: AMR is a critical public health threat in China, especially among the elderly. Effective responses must combine vaccination, curbing antibiotic misuse, and accelerating new antibiotic development.