Antimicrobial resistance burden landscape in Germany in 2019: a comparative country-level estimation

Abstract

Objectives: Our aim was to present the most comprehensive set of pre-COVID-19 antimicrobial resistance (AMR) burden estimates for Germany to date, with a focus on regional variations and hotspots.

Methods: The study estimated deaths and disability-adjusted life-years (DALYs) due to AMR for 23 bacterial pathogens and 88 pathogen-drug combinations in Germany in 2019, with the use of two counterfactual scenarios: deaths attributable to AMR (those that would not have occurred if infections were susceptible) and deaths associated with AMR (cases where AMR was present but not necessarily the cause of death). Models were cross-validated for out-of-sample predictive validity, and uncertainty intervals (UIs) calculated. In stratified analyses we compared death estimates and DALYs with previously published estimates.

Results: The total burden of mortality and DALYs associated with AMR in Germany were 45 692 (95% UI, 31 281-64 591) deaths and 752 697 (500 313-1 076 187) DALYs, respectively, with the total burden attributable to AMR 9648 (6520-13 918) deaths and 159 032 (105 021-232 459) DALYs, respectively. Bloodstream, respiratory and intra-abdominal infections were the major contributors to the fatal AMR burden. The leading pathogens responsible for AMR-associated deaths were Escherichia coli, Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae and Pseudomonas aeruginosa. E. coli resistant to β-lactam/β-lactamase inhibitors and aminopenicillin were top pathogen-drug combinations causing deaths attributable to and associated with AMR, respectively. The presented estimates align with previous research.

Conclusions: The high resistance levels and significant health burden highlight AMR as a serious public health challenge in Germany, emphasizing the need to further strengthen targeted prevention and control measures against key pathogen-drug combinations.

Figure 1

(a) Point estimates and uncertainty intervals of AMR-attributable deaths for selected pathogen-drug combinations, comparison of current estimates with Cassini et al.,⁶ ordered from highest to lowest numbers of deaths. Totals are 2545.9 deaths (Murray et al.¹) and 2210.97 deaths (Cassini et al.⁶). (b) Point estimates and uncertainty intervals of AMR-attributable disability-adjusted life years (DALYs) for selected pathogen-drug combinations, comparison of current estimates with Cassini et al.,⁶ ordered from highest to lowest numbers of DALYs. Totals are 41 809.5 DALYs (Murray et al.¹) and 48 609.51 DALYs (Cassini et al.⁶).