Burden of bacterial antimicrobial resistance 1990–2021 in China: a systematic analysis for the global burden of disease study 2021

China is confronted with a severe burden of antimicrobial resistance (AMR), and to date, there has been no comprehensive estimate of the historical trend of the AMR burden in China. Data on AMR were collected by the Global Antimicrobial Resistance Burden study 1990–2021. Logistic regression, polynomial models, stacked ensemble models, spatiotemporal Gaussian regression models, and mixed-effects meta-regression models are incorporated into the modeling framework to fit the burden of AMR and estimate the number of deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR in two counterfactual scenarios. In 2021, it was estimated that 711,852 (95% uncertainty interval [UI] (586,447–837,256) deaths were associated with bacterial AMR in China, including 160,268 (132,375–188,160) deaths attributable to bacterial AMR. From 1990 to 2021, the number of deaths attributable to AMR among children under 5 years old declined by 95%, while that among the elderly aged 65 and above increased by 68%. Among the 12 infectious syndromes, the top three with the largest number of deaths attributed to AMR in 2021 were bloodstream infections (74,119), lower respiratory tract infections (60,839), and peritoneal and intra-abdominal infections (11,827). Among them, bloodstream infections were the infectious syndrome with the greatest increase in the number of deaths during the study period. In 2021, the pathogen with the highest number of deaths attributed to AMR was Staphylococcus aureus (39,643), and the one with the greatest increase in attributed deaths was Staphylococcus aureus, with an increase of 20,774 (16,880–24,668). In 2021, the pathogen–drug combination causing the highest number of AMR-attributed deaths was methicillin-resistant Staphylococcus aureus (26,023), and the pathogen with the highest annualized rate of change in attributed deaths over 31 years was third-generation cephalosporin-resistant Acinetobacter baumannii (17.5%). Bacterial antimicrobial resistance in China was a serious threat to public health, especially for elderly people. Meanwhile, intervention measures such as popularizing vaccination, reducing the misuse of antibiotics, and developing new antibiotics should be combined to address this significant health threat.