The study highlights global estimates of mortality associated with 33 clinically significant bacterial pathogens

In a recently published study in The lancetresearchers presented comprehensive global estimates of the mortality burden associated with 33 species or genera of bacterial pathogenic organisms causing 11 major infectious syndromes in 2019, using data and methods from the GBD (Global Burden of Disease, Injury and Risk Factors Study) 2019 and the global burden of antibiotic resistance conducted in the same year.

Study: Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the 2019 Global Burden of Disease Study. Credit: nobeastsofierce/Shutterstock
Study: Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the 2019 Global Burden of Disease Study. Credit: nobeastsofierce/Shutterstock

background

Studies predicting mortality from infection by drug-resistant organisms and associated sepsis reported that infections remain a leading cause of death worldwide. Therefore, deaths from infections should be considered an urgent priority for interventions within the global health community. Identifying the pathogens associated with leading infections, infectious syndromes, and associated deaths for each region is critical to implementing targeted prevention efforts.

About the study

In the present study, researchers predicted deaths in 2019 from infections caused by 33 bacterial species or genera responsible for 11 major infection syndromes based on data and methods from the GBD Study and the 2019 Global Burden of Burden Study antimicrobial resistance.

The study included datasets of 343 million individuals spanning 11,361 years with study geographic locations. Three modeling steps were used to estimate the fatal burden associated with the bacterial pathogens, namely: (i) deaths attributed to infections, (ii) the proportion of deaths from infections attributable to specific infection syndromes, and (iii ) the proportion of deaths due to infectious syndromes attributable to specific pathogenic organisms.

The team predicted mortality from infections based on death counts where the cause of death was contagious or death was due to sepsis. The proportion of deaths from bacterial infections attributable to specific infectious syndromes was estimated based on data analyzed by pathogen, gender, geographic location, and age to determine the infectious syndromes that led to sepsis.

The proportion of deaths from specific infectious syndromes attributed to specific pathogens was determined by integrating estimates of the pathogen-specific and infectious syndrome-specific case-fatality ratios (CFRs) with modeled distributions of pathogens for each infectious syndrome by geography location predicted and age. Predictions have been made for all women and men of all ages living in 204 territories and nations in 2019.

Logistic regression modeling with random effects and MEPCO modeling (multinomial estimation with partial and composite observations) were used for the analysis. The team predicted YLLs (Years of Life Lost) associated with each pathogenic organism by converting age-stratified deaths into YLL estimates based on standardized counterfactual life expectancy at a given age.

Types of data sources that could be included in the study included data as follows: vital registry data from multi-cause deaths; hospital discharge dates; link information sources; CHAMPS (Child Health and Mortality Prevention Surveillance) study death surveillance data; laboratory-based passive surveillance data; and literature reviews of microbial organisms responsible for meningitis, lower respiratory tract infections, neonatal sepsis, dermatological infections, urinary tract infections, bone and joint infections, and peritonitis.

Results

In total, an estimated 14 million infection-related deaths were recorded in 2019, of which eight million deaths were attributed to bacteria (susceptible and resistant to antimicrobial agents) responsible for the infectious syndromes analyzed in the study. Mortality from the studied bacterial pathogens was estimated at 14% of all global deaths and 56% of sepsis-related deaths in 2019.

The five major bacterial pathogenic organisms responsible for 55% of bacterial deaths were examined Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa and Streptococcus pneumoniae. The deadliest pathogenic organisms that led to the deadliest infection syndromes varied by age and location. Age-stratified mortality estimates associated with the bacterial pathogens studied were highest in the sub-Saharan African superregion, with a predicted 230.0 deaths per 100,000 people, and lowest among high-income individuals, with 52.0 deaths per 100,000 people.

Staphylococcus aureus has been associated with the highest number of deaths in 135 countries and with the highest number of deaths globally in people over the age of 15, whereas Streptococcus pneumoniae was responsible for most deaths in those under 5.0 years of age. In 2019, >6.0 million deaths were attributed to three infectious syndromes of bacterial origin, with bloodstream and lower respiratory tract infections causing >2.0 million deaths and >1.0 million deaths from intra-abdominal and peritoneal infections, respectively.

In 2019, 304 million YLLs worldwide were associated with the studied bacterial pathogenic organisms, accounting for 18% of the 2019 estimated global YLL. The bacterial pathogens associated with the YLL burden were identical to the fatality estimates S. pneumoniae, S. aureus, K. pneumoniae, E. coli and P. aeruginosa associated with 40 million YLLs, 34 million YLLs, 31 million YLLs, 30 million YLLs, and 19 million YLLs, respectively.

Conclusion

Overall, the study results provided an examination of mortality associated with commonly identified bacterial pathogenic organisms, showing that more than 50% of all bacterial deaths worldwide in 2019 were caused by E. coli, S. aureus, K. pneumoniae, P. aeruginosa and S. pneumoniae.

Findings can guide public health strategies to reduce the global bacterial burden of infection, including infection control and prevention measures, optimization of antibiotic use, improved microbial analysis capacity, vaccine development and implementation, increased dissemination of available vaccines, and primary care service availability.

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