Global burden of antimicrobial resistance in lower respiratory infections: a systematic analysis for the Global Burden of Disease Study 2021

A global analysis of antimicrobial resistance (AMR) in lower respiratory infections (LRIs) shows that in 2021, AMR was associated with 1.64 million deaths, including 400,000 directly attributable to resistant infections. While age-standardized mortality rates have declined since 1990—largely due to strong reductions in children under five—the burden is increasingly shifting toward adults aged 60 and older. The highest impact is seen in sub-Saharan Africa, with men generally more affected than women. Over 90% of deaths are caused by six key pathogens, including Streptococcus pneumoniae and major Gram-negative bacteria such as Klebsiella pneumoniae and Acinetobacter baumannii, with resistance to commonly used antibiotics playing a major role. These findings highlight both progress and emerging challenges, underscoring the urgent need for improved vaccines, better diagnostics, and targeted interventions, particularly to address rising resistance in older populations and hard-to-treat Gram-negative infections.