Antimicrobial-Resistant Infections in the Eastern Mediterranean Region (EMR): Burden, Mortality Trends, and Progress Toward AMR Reduction Milestones (2013–2023)

Background Antimicrobial resistance (AMR) is a rapidly expanding worldwide health concern, disproportionately affecting low- and middle-income countries. The Eastern Mediterranean Region (EMR) presents unique issues, including war, inadequate surveillance systems, and widespread antibiotic abuse. Objective This study evaluates AMR burden, mortality changes between 2013 and 2023, and progress toward AMR reduction milestones in EMR nations using Global Burden of Disease (GBD) AMR-based indicators. Methods This ecological analysis used publicly available IHME and GBD-AMR estimates to examine AMR mortality rates (per 100,000), burden categories, milestone achievements, and AMR ranking among the top 10 causes of death in 2013 and 2023 across EMR countries. Results AMR mortality in the EMR ranged from 4 to 75 deaths per 100,000, with Gulf countries reporting the lowest rates and Pakistan, Afghanistan, Somalia, Yemen, and Djibouti the highest. Twelve countries made no progress between 2019 and 2023, while nine achieved reductions in AMR mortality. In Pakistan, Afghanistan, Somalia, Yemen, and Sudan, AMR ranked among the top 10 causes of death in 2013 and/or 2023, unlike most other EMR countries. Conclusion AMR burden in the EMR varies widely, rising in high-burden, conflict-affected countries with little improvement. Strengthening labs, stewardship, and surveillance is essential. This study provides regional baseline data to guide targeted interventions and national AMR plans.