2019年全球腹腔感染相关细菌耐药性的疾病负担分析

Global burden of bacterial antimicrobial resistance in intra-abdominal infections in 2019

目的分析2019年全球腹腔感染(IAIs)相关细菌对抗菌药物耐药性(AMR)的疾病负担。方法采用2019年全球疾病负担研究数据,通过死亡例数、死亡率、过早死亡损失寿命年、伤残损失寿命年和伤残调整寿命年(DALYs)等指标描述IAIs相关AMR的疾病负担。采用反事实分析法估算由AMR直接和间接造成的疾病负担。结果2019年全球IAIs直接归因于AMR和与AMR间接相关的死亡例数分别为21.03万人和80.49万人,直接归因于AMR和与AMR间接相关的DALYs分别为565.69万人年和2159.35万人年。南亚是IAIs相关AMR导致死亡负担最高的地区,直接导致5.76万人死亡。大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌以及屎肠球菌直接导致全球16.00万人死亡,约占全部病原体的76%。2019年全球有超过62%的IAIs死亡病例(13.08万)可直接归因于对喹诺酮类抗菌药物、碳青霉烯类抗菌药物和第三代头孢菌素产生的AMR。耐喹诺酮类屎肠球菌是导致死亡的重要病原体-抗菌药物组合,有1.99万例死亡病例归因于该细菌导致的AMR。结论IAIs相关AMR仍然是全球公共健康领域面临的重大挑战,应结合不同地区的病原体-抗菌药物组合流行情况和医疗资源的可及性制定相关的预防和控制策略。

Objective To analyze the global anti-microbial resistance(AMR)burden of intra-abdominal infections(IAIs)in 2019.Methods Data were obtained from the results of Global Burden of Disease Study 2019(GBD 2019),including death,years of life lost,year lived with disability,and disability-adjusted life-years(DALYs)for AMR in IAIs.A counterfactual analysis was used to estimate the burden directly and indirectly caused by AMR.Results Globally,there were 210300 deaths attributed to AMR and 804900 deaths associated with bacterial AMR in IAIs in 2019.There were 5.66 million DALYs attributed to AMR and 21.59 million DALYs associated with AMR in IAIs in 2019.The highest burden of AMR was observed in south Asia,directly causing 57620 deaths.Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus,and Enterococcus faecium were directly responsible for 160000 deaths worldwide,accounting for 76%of all pathogens.More than 62%of global deaths(130800)attributed to fluoroquinolones,carbapenems,and third-generation cephalosporins.Fluoroquinolone-resistant Enterococcus faecium was an important pathogen-antimicrobial combination causing death,with 19900 deaths attributed to AMR caused by this bacterium.Conclusions Bacterial AMR in IAIs remains a major challenge in global public health,and prevention and control strategies should be developed in relation to the prevalence of pathogen-antimicrobial combinations in different regions and the accessibility of healthcare resources.