Burden of bacterial antimicrobial resistance in China: a systematic analysis from 1990 to 2021 and projections to 2050

INTRODUCTION: Antimicrobial resistance (AMR) has emerged as a critical health challenge; however, there is a paucity of in-depth reports outlining its burden and trends in China. OBJECTIVES: This study aimed to systematically assess the burden of bacterial AMR in China from 1990 to 2021 and project future trends up to 2050, providing critical insights for AMR control and policy-making. METHODS: We analyzed data from the Global Burden of Disease Study 2021, encompassing 12 infectious syndromes, 64 pathogens (including 22 with AMR), and 84 pathogen-drug combinations. The burden was quantified by deaths and disability-adjusted life years under two counterfactual scenarios: those associated with AMR and those attributable to AMR. Trends were assessed using joinpoint regression analysis, and future projections up to 2050 were modeled using an autoregressive integrated moving average approach. RESULTS: In 2021, AMR was attributable to approximately 160,268 (95% uncertainty intervals [UI]: 132,375-188,160) deaths in China, with up to 711,852 (95% UI: 586,447-837,256) fatalities associated with AMR. The most lethal infectious syndrome was bloodstream infections, with key pathogen-drug combinations including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Streptococcus pneumoniae, and carbapenem-resistant Acinetobacter baumannii. Between 1990 and 2021, there was a substantial decrease in the burden among children under the age of five, primarily due to a decline in fatalities caused by carbapenem-resistant S. pneumoniae. In contrast, the burden increased among individuals aged 45 and older, with MRSA identified as the principal contributor. Projections indicate that by 2050, AMR could be associated with 769,432 deaths in China, of which 180,123 directly attributable to AMR. CONCLUSION: Our findings provide a comprehensive evaluation of AMR burden in China, highlighting the urgent need for targeted interventions to prevent and control resistant infections, particularly among older adults.