Global burden of bacterial antimicrobial resistance among children under five years 1990-2021: a systematic analysis with forecasts to 2050.

Authors

Shanshan Wang, Fei Xie, Shaowei Sang

Published in

International journal of antimicrobial agents. Pages 107995. Aug 31, 2026. Epub Aug 31, 2026.

Abstract

Antimicrobial resistance (AMR) poses a critical threat to child health, particularly in resource-limited settings. A comprehensive assessment of the AMR-related mortality burden in children under five is needed to inform global strategies.
We conducted a secondary analysis of the Global Burden of Disease (GBD) 2021 estimates, extracting AMR-associated and AMR-attributable mortality data for children under five from 1990 to 2021, with projections to 2050. Analyses included historical trends, pathogen- and syndrome-specific burdens, and future projections under a reference scenario and two alternative scenarios. The alternative scenarios included a scenario assuming future drug development that targets Gram-negative pathogens (Gram-negative drug scenario) and a scenario assuming future improvements in health-care quality and access to appropriate antimicrobials (better care scenario).
In 2021, AMR was associated with 0.84 million (95% UI 0.64-1.04) and attributable to 0.19 million (0.14-0.24) deaths globally in children under five, reflecting a substantial decline since 1990. Substantial regional disparities persisted, with Sub-Saharan Africa bearing the highest burden. Streptococcus pneumoniae accounted for largest number of AMR-associated deaths, while Klebsiella pneumoniae accounted for largest number of AMR-attributable deaths. Bloodstream infections and lower respiratory infections accounted for the majority of AMR-related mortality. For AMR-attributable deaths, key pathogen-drug combinations included beta-lactam-resistant S. pneumoniae, methicillin-resistant Staphylococcus aureus, and carbapenem-resistant Acinetobacter baumannii. Projections to 2050 indicate a continued decline. From 2025 to 2050, the better care scenario was projected to avert an estimated 10.65 million deaths, substantially exceeding the 1.09 million deaths averted under the Gram-negative drug scenario.
Despite a declining global trend, AMR remains a pressing cause of mortality in children under five, marked by severe inequity. The persistent burden from multidrug-resistant Gram-negative pathogens underscores the need for comprehensive strategies that extend beyond antibiotic development, prioritizing improved healthcare access, infection prevention, and vaccination, especially in high-burden regions.

PMID:
42674241
Bibliographic data and abstract were imported from PubMed on 01 Sep 2026.

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