Burden of antimicrobial resistance in the WHO Southeast Asia and Western Pacific Regions, 1990–2021: a cross-country systematic analysis with forecasts to 2050

Xiao-Ran Yu; Huan Wang; Jian Wang; Xin Yuan; Xiao-Ding Zhou; Qiu-Shui He; Igor Mokrousov; Lin Sun; Yan-Hui Dong; Zhi-Yong Zou

doi:10.1016/j.mmr.2026.100002

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Burden of antimicrobial resistance in the WHO Southeast Asia and Western Pacific Regions, 1990–2021: a cross-country systematic analysis with forecasts to 2050

RESEARCH | Updated：2026-05-11

- Burden of antimicrobial resistance in the WHO Southeast Asia and Western Pacific Regions, 1990–2021: a cross-country systematic analysis with forecasts to 2050
- Burden of antimicrobial resistance in the WHO Southeast Asia and Western Pacific Regions, 1990–2021: a cross-country systematic analysis with forecasts to 2050
- 军事医学研究（英文） 2026年
- Affiliations：
  
  Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
  Finnish Reference Laboratory for Pertussis and Diphtheria, Institute of Biomedicine/InFLAMES Research Flagship Center, University of Turku, Turku 20014, Finland
  Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, St. Petersburg 197101, Russia
  Henan International Joint Laboratory of Children’s Infectious Diseases, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital, Zhengzhou 450018, China
  Laboratory of Respiratory Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Center for Children’s Health, Beijing 100045, China
  School of Public Health, Shenzhen University Medical School, Shenzhen 518060, Guangdong, China
- Author bio：
  
  *Lin Sun, sunlinbch@163.com;
  Yan-Hui Dong, dongyanhui@bjmu.edu.cn;
  Zhi-Yong Zou, harveyzou2002@bjmu.edu.cn
- Funds：
  
  the National Natural Science Foundation of China(82073573;82373593;82103865);the National Key R&D Program of China(2024YFC3308302);the Peking University Talent Introduction Program Project(BMU2023Y1011);the National Ten Thousand Talents Program for Youth Talent Excellence;the Beijing Natural Science Foundation(L246011;7222244);the Training Plan for High-Level Public Health Technical Talents of Beijing Municipal Health Commission(2022-02-04)
- DOI：10.1016/j.mmr.2026.100002
  中图分类号：
- 收稿：2025-06-09，
  
  修回：2026-03-05，
  
  纸质出版：2026-03
- Accepted：
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Xiao-Ran Yu, Huan Wang, Jian Wang, 等. Burden of antimicrobial resistance in the WHO Southeast Asia and Western Pacific Regions, 1990–2021: a cross-country systematic analysis with forecasts to 2050[J/OL]. 军事医学研究（英文）, 2026.

Yu XR, Wang H, Wang J, Yuan X, Zhou XD, He QS, et al. Burden of antimicrobial resistance in the WHO Southeast Asia and Western Pacific Regions, 1990–2021: a cross-country systematic analysis with forecasts to 2050. Mil Med Res. 2026;13(1):100002.
Xiao-Ran Yu, Huan Wang, Jian Wang, 等. Burden of antimicrobial resistance in the WHO Southeast Asia and Western Pacific Regions, 1990–2021: a cross-country systematic analysis with forecasts to 2050[J/OL]. 军事医学研究（英文）, 2026. DOI： 10.1016/j.mmr.2026.100002.

Yu XR, Wang H, Wang J, Yuan X, Zhou XD, He QS, et al. Burden of antimicrobial resistance in the WHO Southeast Asia and Western Pacific Regions, 1990–2021: a cross-country systematic analysis with forecasts to 2050. Mil Med Res. 2026;13(1):100002. DOI： 10.1016/j.mmr.2026.100002.

摘要

Abstract

Background:

Antimicrobial resistance (AMR) constitutes a critical global health challenge with major implications for public health and economic stability

increasing infection- and sepsis-related mortality. Despite growing evidence on its contribution to disease burden

comprehensive assessments of long-term trends at the regional level remain limited in the World Health Organization (WHO) Southeast Asia Region (SEAR) and Western Pacific Region (WPR).

Methods:

We used data from the Global Research on Antimicrobial Resistance (GRAM) Project to evaluate sepsis-and AMR-related deaths and disability-adjusted life-years (DALYs) for 11 infectious syndromes

22 pathogens

and 84 pathogen-drug combinations across 42 countries and territories in the WHO SEAR and WPR from 1990 to 2021. AMR burden was estimated under two counterfactual scenarios: deaths and DALYs attributable to AMR (representing the burden if drug-resistant infections were replaced by drug-susceptible infections)

and deaths and DALYs associated with AMR (representing the burden if infections did not occur at all). We reported numbers

crude rates

and age-standardized rates

and generated forecasts of AMR burden to 2050 using an autoregressive integrated moving average model.

Results:

In SEAR and WPR

there were 8.36×10

[95% uncertainty interval (UI) 7.93–8.79

]

sepsis-related deaths in 1990

which decreased to 6.03×10

(95% UI 5.68–6.39) in 2019 before increasing to 8.31×10

(95% UI 7.86–8.76) in 2021. The number of deaths associated with AMR ranged from 2

445

875 (95% UI 2

221

769–2

670

192) in 1990 to 2

358

190 (95% UI 2

173

521–2

545

190) in 2021

while deaths attributable to AMR ranged from 546

479 (95% UI 487

669–605

277) to 587

103 (95% UI 534

165–639

903) over the same period. From 1990 to 2021

deaths attributable to AMR decreased among people

25 years

with a 76.1% [95% confidence interval (CI) 70.6–81.6

]

reduction occurring among children

5 years

while those among adults aged ≥70 years more than doubled

increasing from 133

013 (95% UI 124

066–141

922) to 298

366 (95% UI 284

023–312

475). The largest increase in the number of deaths attributable to AMR was caused by methicillin-resistant St

aphylococcus aureus [from 30

168 (95% UI 24

956–35

351) in 1990 to 66

946 (95% UI 57

544–76

479) in 2021

]

. In 2021

Kiribati had the highest age-standardized mortality rate (per 100

000 person-years) attributable to AMR [30.9 (95% UI 24.1–37.8)

]

whereas New Zealand had the lowest [3.2 (95% UI 2.6–3.8)

]

among the two regions. By 2050

the number of deaths associated with AMR is predicted to reach 3

875

753 (95% UI 1

502

402–9

998

297) in these two regions

of which 952

592 (95% UI 766

353–1

184

090) deaths are attributable to AMR.

Conclusions:

This study highlights the escalating burden of AMR in SEAR and WPR

emphasizing the urgent need for attention to this persistent and growing crisis. Our analyses underscore the dual challenge of sustaining gains among people <25 years while addressing the alarming increase of AMR in elderly populations. Given the high variability of AMR burden by pathogen

age group

and country

strengthened surveillance and improved laboratory capacity are essential to accurately characterize resistance patterns and guide clinical decision-making.

关键词

Keywords

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