Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019
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Résumé
BACKGROUND: Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. METHODS: We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. FINDINGS: From an estimated 13·7 million (95% UI 10·9-17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7-10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2-18·1) of all global deaths and 56·2% (52·1-60·1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54·9% (52·9-56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4-71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. INTERPRETATION: The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. FUNDING: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund.
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La notice
- Revue
- The Lancet
- Thématique
- Antibiotic Use and Resistance
- Domaine
- Immunology and Microbiology
- Établissements canadiens
- —
- Organismes subventionnaires
- NIH Clinical CenterNational Institute of Allergy and Infectious DiseasesNational Heart, Lung, and Blood InstituteZabol University of Medical SciencesRussian Academy of SciencesFundação para a Ciência e a TecnologiaNational Health and Medical Research CouncilMedical Research CouncilDefense Threat Reduction AgencyLeibniz-GemeinschaftDilla UniversityMadda Walabu UniversityUniversitatea SapientiaUniversitas PadjadjaranJenderal Soedirman UniversityUniversiti Sultan Zainal AbidinImam Abdulrahman Bin Faisal UniversityLingnan UniversityHellenic Foundation for Research and InnovationLorestan University of Medical SciencesMonash University MalaysiaUniversity of PeradeniyaXiamen UniversityZanjan University of Medical SciencesNational Research, Development and Innovation OfficeNational Nutrition and Food Technology Research InstituteTanta UniversityIlam UniversityUniversity of TabrizUniversity of Health and Allied SciencesUniversitatea de Medicină şi Farmacie "Carol Davila" BucureştiUniversity of the PhilippinesSecretaría Nacional de Ciencia, Tecnología e InnovaciónOulun YliopistoMinistério da Ciência, Tecnologia e Ensino SuperiorUniversidad de la República UruguayBahir Dar UniversityDirectorate for Biological SciencesGöteborgs UniversitetShahrekord University of Medical SciencesUniversità Cattolica del Sacro CuoreUniversità degli Studi del Piemonte OrientaleTehran Heart CenterJawaharlal Institute Of Postgraduate Medical Education and ResearchBinzhou Medical UniversityUniversitetet i OsloMasarykova UniverzitaQazvin University of Medical SciencesUniversitair Medisch Centrum GroningenUniversitas Syiah KualaShiraz UniversityAutoritatea Natională pentru Cercetare StiintificăAhvaz Jundishapur University of Medical SciencesSüleyman Demirel ÜniversitesiShahrekord UniversityNational Institutes of HealthUniversity of Veterinary and Animal SciencesChinese University of Hong KongKing Fahad Medical CityHaramaya UniversityUniversiti Sains MalaysiaUniversiti Kebangsaan MalaysiaAlfaisal UniversityUniversity of GondarCity University of Hong KongTeva Pharmaceutical IndustriesUniversity of WaterlooKuwait UniversityDepartment of Science and Technology, Ministry of Science and Technology, IndiaSultan Qaboos UniversityAin Shams UniversityShiraz University of Medical SciencesBGI GroupKing Abdulaziz UniversityUniversità degli Studi di GenovaIsfahan University of Medical SciencesBundesministerium für GesundheitGolestan University of Medical SciencesUniversity of CalcuttaAmarin CorporationIslamic Azad UniversityGachon UniversityKyung Hee UniversityKing Saud UniversityTorbat Heydariyeh University of Medical SciencesBundesministerium für Bildung und ForschungShahroud University of Medical SciencesIlam University of Medical SciencesJames Cook UniversityInternational Centre for Diarrhoeal Disease Research, BangladeshWashington University in St. LouisMonash UniversityTabriz University of Medical SciencesUniversity of Cape TownNational Authority for Scientific Research and InnovationKhalifa University of Science, Technology and ResearchUniversity of Technology SydneyCharles Sturt UniversityWuhan UniversityAteneo de Manila UniversityUniversity of WashingtonRijksuniversiteit GroningenNational Human Genome Research InstituteArizona State UniversityMacquarie UniversityFogarty International CenterCOMSATS Institute of Information TechnologyNational University of SingaporeUniversitatea din BucureștiLa Trobe UniversityUnitatea Executiva pentru Finantarea Invatamantului Superior, a Cercetarii, Dezvoltarii si InovariiUniversity of OxfordIndian Council of Medical ResearchUniversità di BolognaShahid Beheshti University of Medical SciencesPrince Sattam bin Abdulaziz UniversityCancer Institute NSWUniversity College LondonUniversity of WarwickUniversity of LeicesterDire Dawa UniversityDepartment of Health and Social CareNational Institute for Health and Care ResearchInvitaeSemmelweis EgyetemDeakin UniversityPirogov Russian National Research Medical UniversitySaveetha Dental CollegeKasturba Medical College, ManipalNankai UniversityFlinders UniversityMinistero della SaluteInstituut voor Tropische GeneeskundeNational Center of Neurology and PsychiatryUniversity of Southern CaliforniaAlexander von Humboldt-StiftungTribhuvan UniversityMekelle UniversityUniversity of ReadingWollega UniversitySeres TherapeuticsJanssen PharmaceuticalsU.S. Department of Veterans AffairsRafsanjan University of Medical SciencesUniversitas RiauInstitute for Health Metrics and EvaluationInternational Medical UniversityWellcome TrustJohns Hopkins UniversityIran University of Medical SciencesIndiana University HealthDongguk UniversityUK Research and InnovationRice UniversityJazan UniversityUniversity of Central PunjabSocial Science Research CouncilEuropean Regional Development FundKU LeuvenUniversity of South CarolinaLondon South Bank UniversityMinisterul Cercetării, Inovării şi DigitalizăriiHamad Medical CorporationPfizerBill and Melinda Gates FoundationTechnische Universität BerlinUniversidade da Beira InteriorMansoura UniversityModernaTehran University of Medical Sciences and Health ServicesKaiser PermanenteBournemouth UniversityNIHR Sheffield Biomedical Research CentreRush UniversityAmgenRajarata University of Sri LankaShaqra UniversityYale UniversityKrishna Institute Of Medical Sciences Deemed To Be UniversityUniversity of ZanjanFlorida International UniversityBushehr University of Medical SciencesSanofiNational Institute of General Medical SciencesMahidol UniversityYasuj University of Medical SciencesMongolian National University of Medical SciencesUniversity of New South Wales
- Mots-clés
- Public healthMedicineInfectious disease (medical specialty)Global healthBurden of diseaseAntibiotic resistanceDisease burdenCause of deathDiseaseAntimicrobialPathogenEnvironmental healthImmunologyBiologyAntibioticsPopulationMicrobiologyInternal medicine
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