The burden of bacterial antimicrobial resistance in the South Asia and high-income Asia-Pacific region over three decades: a systematic analysis

Background Antimicrobial resistance (AMR) is an escalating global public health crisis, yet regional disparities remain poorly characterized. This study systematically assessed AMR burden in South Asia and High-income Asia-Pacific (1990–2021) to inform targeted control strategies. Methods We analyzed data from the Global Burden of Antimicrobial Resistance Study 2021, which serves as the most advanced and current database for assessing the burden of AMR. The study covered 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes in countries and territories across South Asia and High-income Asia-Pacific regions. We quantified the deaths burden under two counterfactual scenarios: deaths associated with AMR and deaths attributable to AMR. In addition, based on these data, we calculated the estimated annual percentage change (EAPC) to evaluate the temporal trends in AMR death rate. Results In 2021, South Asia recorded approximately 1.26 million (95% UI: 1.11 to 1.42 million) AMR-associated deaths and 334,671 (95% UI: 282,451 to 386,890) AMR-attributable deaths, while the High-income Asia-Pacific region reported 108,668 (95% UI: 92,005 to 125,331) and 23,717 (95% UI: 20,074 to 27,360). AMR-associated death rate declined in South Asia(EAPC: −1.88) but increased in High-income Asia-Pacific (EAPC: 0.74). Over three decades, marked variations emerged across regions and age groups. AMR-associated deaths among children under 5 years declined substantially-by 70% in South Asia and 90% in High-income Asia-Pacific. In contrast, adults 70 + years increased by 155% and 70%, respectively. In 2021, India (69.8 per 100,000) and Japan (65.66 per 100,000) exhibited the highest regional AMR-associated death rates. Aminopenicillin-resistant Escherichia coli predominated in South Asia, whereas methicillin-resistant Staphylococcus aureus (MRSA) was most prevalent in AMR-associated deaths in the High-income Asia-Pacific. Conclusion This evaluation reveals divergent AMR burden trends between regions, highlighting the critical need for tailored interventions, particularly targeting the growing vulnerable aging population.