The burden of bacterial antimicrobial resistance in the WHO Eastern Mediterranean Region 1990–2021: a cross-country systematic analysis with forecasts to 2050

A comprehensive time-trend analysis of antimicrobial resistance (AMR) in the WHO Eastern Mediterranean Region (EMR) from 1990–2021, with forecasts to 2050, reveals a persistent and growing public health crisis. In 2021, an estimated 380,000 deaths were associated with AMR and 92,800 deaths were directly attributable to it. Over the past three decades, AMR-related deaths among children under five decreased by 50%, while deaths in adults aged 70+ increased by nearly 86%. Six pathogens — Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa — accounted for most of the burden, with S. aureus showing the steepest rise. Mortality rates were highest in Somalia and lowest in Qatar. By 2050, deaths attributable to AMR in the EMR are projected to rise to 187,000, with 752,000 deaths associated with resistance overall. The study underscores the urgent need for stronger regional coordination, targeted national strategies, and sustained multisectoral collaboration to curb AMR in the region.