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

Lower respiratory infections (LRIs) remain a leading cause of death and disability. AMR is considered as a paramount twenty-first century public health threat. To assess the global burden of AMR-associated LRIs using data from Global Burden of Disease (GBD) 2021. Mortality data, including absolute counts, age-standardized mortality rates (ASMRs), and AMR-specific metrics, were extracted from the GBD 2021 dataset and stratified by demographic characteristics (age groups, sex), geographic regions, and socioeconomic status (SDI tiers). From 1990 to 2021, both absolute death counts and ASMRs demonstrated significant declines (EAPC: − 2.09); mortality burden (the death counts and ASMRs) caused by bacteria with AMR are 2 to 3 times that of bacteria with AMS; highest burden was observed in low-SDI regions and increasing trends were noted among older adults (≥ 50 years); S. pneumoniae dominated overall mortality, and S. aureus showed concerning upward trends; the mortality related to carbapenem-resistant A. Baumannii, E. coli, K. pneumoniae, and P. aeruginosa was on the rise. While overall burden of AMR-associated LRIs mortality shows a declining trajectory, significant disparities persist across SDI strata. The emergence of resistance to last-resort antimicrobials of the leading bacterial pathogens highlights the urgent need for the prevention and control of AMR.