Global burden of lower respiratory infections associated with antimicrobial resistance: insights from the Global Burden of Disease 2021

This study analysed Global Burden of Disease (GBD) 2021 data to assess the global impact of antimicrobial resistance (AMR) in lower respiratory infections (LRIs). Between 1990 and 2021, overall deaths and age-standardised mortality rates declined significantly; however, mortality linked to resistant bacteria remains 2–3 times higher than mortality from susceptible strains. The burden is disproportionately concentrated in low–Socio-Demographic Index (SDI) regions and is increasing among adults aged 50 years and older. Streptococcus pneumoniae remains the leading cause of AMR-associated LRI deaths overall, while Staphylococcus aureus shows rising trends. Notably, mortality related to carbapenem-resistant Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa is increasing. Despite overall progress, persistent inequalities and growing resistance to last-resort antibiotics underscore the urgent need for strengthened AMR prevention and control strategies globally.