Global and regional burden of bacterial antimicrobial resistance in endocarditis in 2019: a systematic analysis

Abstract Background The burden of endocarditis has sharply increased and antimicrobial resistance (AMR) poses an urgent threat to human health worldwide. There are currently no detailed data about the burden of bacterial AMR in endocarditis. This study aimed to comprehensively investigate the AMR burden of endocarditis to date. Methods We obtained data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). We estimated deaths, disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) attributable to and associated with bacterial AMR in endocarditis for 7 GBD super-regions, 21 regions, 16 bacterial pathogens, 14 antibiotic classes, and 68 pathogen-antibiotic combinations in 2019. Five broad components were the backbone of our approach and the estimates were based on two counterfactual scenarios: drug-susceptible infection and no infection. Results Globally, there were 16.37 thousand deaths (95% uncertainty interval [UI]: 11.54–23.05) attributed to and 65.59 thousand deaths (95% UI: 47.15–91.12) associated with bacterial AMR in endocarditis in 2019. The all-age death rates were higher in central Europe and high-income regions, and lower in sub-Saharan Africa. Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae played the dominant roles in AMR, and high resistance to various multiple antibiotics, including fluoroquinolones, carbapenems, third-generation cephalosporins, and methicillin. There were 2 pathogen-antibiotic combinations that caused more than 1000 resistance-attributable deaths: methicillin-resistant Staphylococcus aureus and carbapenem-resistant Acinetobacter baumannii. Conclusions AMR in endocarditis is a non-ignorable health problem, and it is an urgent priority to identify tailored strategies that can effectively reduce the burden of bacterial AMR in endocarditis based on region-specific pathogen-antibiotic condition and resources.