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

Summary
This systematic review and meta-analysis examined the impact of antimicrobial resistance (AMR) on mortality in hospitalised patients. Across 34 studies (20,658 patients) from 18 mainly high- and middle-income countries, AMR was found in over one-third of hospital-acquired infections (pooled prevalence: 36.5%). Patients with AMR infections had a significantly higher risk of death compared to those with susceptible infections (adjusted pooled RR: 1.58). The risk was particularly high for in-hospital mortality and AMR-related bacteraemia.

However, evidence was limited by publication bias, low certainty of mortality estimates, and a lack of data from key regions (Africa, India, the Middle East, Russia). Few studies modelled transmission-related mortality.

Conclusion: AMR is common in hospitals worldwide and significantly increases mortality risk, highlighting the urgent need for more research—especially in underrepresented regions—to guide interventions reducing AMR transmission and deaths in hospital settings.