| Congresso Brasileiro de Microbiologia 2023 | Resumo: 1496-1 | ||||
Resumo:Antimicrobial resistance (AMR) is a pressing global health concern which poses a significant challenge to modern healthcare. Despite a long history of resistance surveillance in the WHO Region of the Americas, accurately quantifying its impact has remained elusive, which is why we aimed to provide a comprehensive assessment of the AMR burden for this specific region. To gauge the extent of AMR burden, the study estimated deaths and disability-adjusted life-years (DALYs) associated with and attributable to AMR for 23 bacterial pathogens and 88 pathogen-drug combinations across countries in the WHO Region of the Americas for the year 2019. Data were sourced from mortality registries, surveillance systems, hospital records, systematic literature reviews, and other credible sources. Predictive statistical models were applied to generate estimates for AMR burden for all countries in the Americas. The methodology revolved around five key elements: determining the number of deaths where infection played a role, establishing the proportion of infectious deaths attributed to a specific infectious syndrome, identifying the proportion of infectious syndrome deaths attributable to a particular pathogen, ascertaining the percentage of pathogens resistant to specific antibiotic classes, and quantifying the excess risk of mortality (or infection duration) associated with this resistance. These components were then utilized to calculate disease burden by contrasting two counterfactual scenarios: deaths attributable to AMR (compared to a scenario where resistant infections are replaced by susceptible ones), and deaths associated with AMR (compared to a scenario where resistant infections do not occur at all). The final estimates were presented with 95% uncertainty intervals (UIs), and models were cross-validated for out-of-sample predictive validity. We estimated that in 2019, there were approximately 569,000 deaths (95% UI 406,000–771,000) associated with bacterial AMR and 141,000 deaths (99,900–196,000) attributable to bacterial AMR across the 35 countries in the WHO Region of the Americas. Notably, lower respiratory and thorax infections represented the most substantial fatal burden of AMR in the region, with 189,000 deaths (149,000–241,000) associated with bacterial resistance, followed by bloodstream infections and peritoneal/intra-abdominal infections. In terms of deaths associated with resistance, six leading pathogens were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, which together accounted for 452,000 deaths (326,000–608,000) associated with AMR. Methicillin-resistant S. aureus and aminopenicillin-resistant E. coli were predominant pathogen-drug combinations for deaths attributable to and associated with AMR in this region, respectively. Our findings underscore the substantial threat that AMR poses to health in the Americas, encompassing a range of countries, infectious syndromes, and pathogen-drug combinations. Countries with limited access to basic healthcare services often bear the highest age-standardized mortality rates linked to and caused by AMR, necessitating specific policy interventions. The presented evidence can guide tailored mitigation efforts for each country in terms informing decisions concerning funding and resource allocation. Successful AMR management in the Americas will hinge on collaborative and multisectoral efforts. Palavras-chave: antimicrobial resistance, bacteria, burden, WHO Region of the Americas | |||||