Burden of infectious diseases and bacterial antimicrobial resistance in China: a systematic analysis for the global burden of disease study 2019

Chi Zhang; Xinghuan Fu; Yiqi Liu; Hong Zhao; Guiqiang Wang

doi:10.1016/j.lanwpc.2023.100972

Burden of infectious diseases and bacterial antimicrobial resistance in China: a systematic analysis for the global burden of disease study 2019

Lancet Reg Health West Pac. 2023 Nov 22:43:100972. doi: 10.1016/j.lanwpc.2023.100972. eCollection 2024 Feb.

Authors

Chi Zhang¹, Xinghuan Fu¹, Yiqi Liu¹, Hong Zhao^{1

2}, Guiqiang Wang^{1

2}

Affiliations

¹ Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, 100034, China.
² Department of Infectious Diseases, Peking University International Hospital, Beijing, 102206, China.

Abstract

Background: Infectious diseases and antimicrobial resistance (AMR) has become pressing concerns in China. We aimed to comprehensively investigate the burden of them.

Methods: Data on infectious diseases and AMR were collected by the Global Antimicrobial Resistance Burden study 2019. Multinomial network meta-regression, logistic regression, and ensemble Spatiotemporal Gaussian process regression were used to fit the number and rate in DisMod-MR 2.1 modelling framework. We reported the number and rates of the disease burdens of 12 infectious syndromes by age and sex; described the burden caused by 43 pathogens; estimated the AMR burden of 22 bacteria and bacteria-antibiotics combinations.

Findings: There were an estimated 1.3 million (95% uncertainty intervals, UI 0.8-1.9) infection-related deaths, accounting for 12.1% of the total deaths in China 2019. Males were 1.5 times more affected than females. Bloodstream infections (BSIs) were most lethal infectious syndrome, associating with 521,392 deaths (286,307-870,583), followed by lower respiratory infections (373,175), and peritoneal and intra-abdominal infections (152,087). These five leading pathogens were S aureus, A baumannii, E coli, S pneumoniae, and E spp., which were associated with 41.2% (502,658/1,218,693) of all infection-related deaths. The pathogens of different infectious syndromes exhibited significant heterogeneity. In 2019, more than 600 thousand deaths were associated with AMR, including 145 thousand deaths attributable to AMR. The top 3 AMR attributable to death were carbapenems-resistance A baumannii (18,143), methicillin-resistance S aureus (16,933) and third-generation cephalosporins-resistance E coli (8032).

Interpretation: Infectious diseases and bacterial antimicrobial resistance were serious threat to public health in China, related to 1.3 million and more than 600 thousand deaths per-year, respectively. Antimicrobial stewardship was urgent.

Funding: This work was supported by National Natural Science Foundation of China (82270626); China Mega-Project for Infectious Diseases (2017ZX10203202, 2013ZX10002005); the Project of Beijing Science and Technology Committee (Z191100007619037).

Keywords: Antimicrobial resistance; Burden of infectious diseases; China; DALYs; Death.