医微客 - 2019年与33种细菌病原体相关全球死亡率：2019年全球疾病负担研究系统分析

2019年与33种细菌病原体相关全球死亡率：2019年全球疾病负担研究系统分析

临床医学

2022-12-02

1029 0

SCI 30 November 2022

Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019

(Lancet, IF: 202.731)

Collaborators GBDAR. Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022. DOI: 10.1016/S0140-6736(22)02185-7.

Correspondence to: Prof Mohsen Naghavi, Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, WA 98195, USA. nagham@uw.edu

Background 背景

Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes.

减少感染造成的死亡负担是一项紧迫的全球公共卫生优先事项。以前的研究评估了与耐药感染和败血症有关的死亡人数，并发现感染仍然是全球死亡的主要原因。了解常见细菌病原体（包括对抗菌素敏感和耐药的病原体）的全球负担对于确定对公共卫生的最大威胁至关重要。据我们所知，这是第一项对11种主要感染综合征中的33种细菌病原体相关的死亡进行全球综合评估的研究。

Methods 方法

We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2.5th and 97.5th percentiles across 1000 posterior draws for each quantity of interest.

我们使用《2019年全球疾病、伤害和风险因素负担研究》（GBD）中的方法，以及《2019年全球抗微生物药物耐药负担研究》中描述的输入数据子集，评估了2019年与11种感染综合征中33个细菌属或种相关的死亡。这项研究包括了3.43亿个个体记录或分离物，涵盖了11361个研究地点年。我们使用了三个建模步骤来评估与每种病原体相关的死亡人数：与感染有关的死亡人数，可归因于某一特定感染综合征的感染造成的死亡人数比例，以及可归因于某一特定病原体的感染综合征造成的死亡人数比例。2019年，对204个国家和地区的所有年龄的男性和女性进行了评估。采用标准GBD方法计算与33种细菌病原体相关的死亡和感染的最终估计95%不确定区间（UIs），对每个兴趣量在1000个后验图中取2.5和97.5百分位。

Findings 结果

From an estimated 13·7 million (95% UI 10·9-17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7-10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2-18·1) of all global deaths and 56·2% (52·1-60·1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54·9% (52·9-56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4-71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths.

2019年与感染相关的死亡人数估计为1370万（95% UI为1090-1710万），其中有770万（570 – 1020万）与本研究估计的11种感染综合征中的33种细菌病原体（包括耐药和对抗菌素敏感的病原体）有关。我们估计，2019年与33种细菌病原体相关的死亡人数占全球总死亡人数的13.6%（10.2 - 18.1），占所有败血症相关死亡人数的56.2%（52.1 – 60.1）。在调查的细菌中，五种主要病原体——金黄色葡萄球菌、大肠杆菌、肺炎链球菌、肺炎克雷伯菌和铜绿假单胞菌——造成了54.9%（52.9 - 56.9）的死亡。最致命的感染综合征和病原体因地点和年龄而异。与这些细菌病原体相关的年龄标准化死亡率在撒哈拉以南非洲地区最高，为每10万人230例死亡（185-285例），在高收入地区最低，为每10万人55.2例死亡（37·4 - 71.5例）。在135个国家中，金黄色葡萄球菌是导致死亡的主要细菌，在全球范围内，它也与15岁以上人群的大多数死亡有关。在5岁以下儿童中，肺炎链球菌是导致死亡人数最多的病原体。2019年，有600多万人死于三种细菌感染综合征，下呼吸道感染和血流感染分别导致200多万人死亡，腹膜和腹腔内感染导致100多万人死亡。

Interpretation 解释

The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development.

我们在这项研究中调查的33种细菌病原体是全球健康损失的一个重要来源，它们在不同感染综合征和地区的分布有很大差异。与GBD 3级基本死因相比，2019年与这些细菌相关的死亡将成为全球第二大死亡原因；因此，应将它们视为全球卫生界干预的紧急优先事项。解决细菌感染负担的战略包括感染预防、优化抗生素的使用、提高微生物分析能力、疫苗开发以及更好和更广泛地使用现有疫苗。这些估计可用于帮助确定疫苗需要、需求和开发的优先事项。