全球腹腔感染相关细菌耐药性疾病负担分析—

全球腹腔感染相关细菌耐药性疾病负担分析——基于GBD2021数据库

单位：1. 江苏卫生健康职业学院临床学院, 江苏南京 211800;
2. 镇江市高等专科学校卫生护理学院, 江苏镇江 212028

分类号：R183

出版年·卷·期（页码）：2025·53·第十二期（1920-1926）

摘要：

目的：分析2021年全球腹腔感染(IAIs)相关细菌耐药性(AMR)的疾病负担特征，为制定精准防控策略提供数据支撑。方法：基于2021年全球疾病负担研究(GBD)数据，通过死亡例数、死亡率、过早死亡损失寿命年(YLLs)、伤残损失寿命年(YLDs)及伤残调整寿命年(DALYs)等指标，描述IAIs相关AMR的负担水平，并运用反事实分析法区分AMR直接与间接导致的疾病负担差异。结果：2021年全球IAIs中，AMR直接致死7.91万人，间接相关死亡32.89万人；对应的DALYs分别为216.11万人年和880.66万人年。约57%的感染死亡病例(129.92万例)与细菌对碳青霉烯类、氟喹诺酮类药物及甲氧西林的耐药性相关。病原体层面，大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌及屎肠球菌是IAIs主要致病源，共造成18.67万人死亡，占全部病原体致死总数的58%，其中大肠埃希菌AMR致死人数居首，直接导致1.45万人死亡。地区分布上，南亚是IAIs相关AMR死亡负担最重的区域，直接死亡1.63万人。结论：IAIs相关AMR仍是全球公共卫生领域的严峻挑战，需结合各地区病原体分布特征、耐药谱模式及医疗资源可及性，制定差异化防控策略。

Objective: To analyze the global disease burden of antimicrobial resistance(AMR) in bacteria associated with intra-abdominal infections(IAIs) in 2021, so as to provide data support for formulating precise prevention and control strategies. Methods: Data from the Global Burden of Disease Study(GBD) 2021 were used, and indicators such as the number of deaths, mortality rate, years of life lost due to premature death(YLLs), years lived with disability(YLDs), and disability-adjusted life years(DALYs) were adopted to describe the burden level of IAIs-related AMR. The counterfactual analysis method was used to distinguish the differences in disease burden directly and indirectly caused by AMR. Results: In 2021, globally, AMR directly caused 79 100 deaths and was indirectly associated with 328 900 deaths in IAIs; the corresponding DALYs were 2.161 1 million person-year and 8.806 6 million person-year, respectively. Approximately 57% of infections-related death cases(1.299 2 million cases) were associated with bacterial resistance to carbapenems, fluoroquinolones, and methicillin. At the pathogen level, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecium were the main pathogenic sources, causing a total of 186 700 deaths, accounting for 58% of the total deaths caused by all pathogens. Among them, Escherichia coli AMR caused the highest number of deaths, directly leading to 14 500 deaths. In terms of regional distribution, South Asia had the heaviest death burden from IAIs-related AMR, with 16 300 direct deaths. Conclusion: The study indicated that IAIs-related AMR remains a severe challenge in the global public health field, and it is necessary to formulate differentiated prevention and control strategies based on the pathogen distribution characteristics, drug resistance spectrum patterns, and accessibility of medical resources in various regions.

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