Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050

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28 September 2024 Elsevier B.V.

The Lancet
2024 #404 Issue 10459 1199 - 1226 pp.

Background: Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts. Methods: We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen–drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level. Findings: In 2021, we estimated 4·71 million (95% UI 4·23–5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00–1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000–372 000] and 57 200 attributable deaths [34 100–80 300] in 1990, to 550 000 associated deaths [500 000–600 000] and 130 000 attributable deaths [113 000–146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000–834 000) in 1990, to 1·03 million associated deaths (909 000–1·16 million) in 2021, and from 127 000 attributable deaths (82 100–171 000) in 1990, to 216 000 (168 000–264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56–2·26) deaths attributable to AMR and 8·22 million (6·85–9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2–69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5–89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (–6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8–102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08–13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths. Interpretation: This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050. Funding: UK Department of Health and Social Cares Fleming Fund using UK aid, and the Wellcome Trust.

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Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
Department of Pediatrics, University of Washington, Seattle, WA, United States
Department of Applied Mathematics, University of Washington, Seattle, WA, United States
School of Health Systems and Public Health, University of Washington, Seattle, WA, United States
Department of Biostatistics, University of Washington, Seattle, WA, United States
Department of Global Health, University of Washington, Seattle, WA, United States
Department of Pharmacy, University of Washington, Seattle, WA, United States
GBD Collaborating Unit, Bergen, Norway
Norwegian Institute of Public Health, Bergen, Norway
Division of Infectious Diseases, Veterans Affairs Greater Los Angeles, Los Angeles, CA, United States
Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
Big Data Institute, University of Oxford, Oxford, United Kingdom
The Global Research on Antimicrobial Resistance Project, University of Oxford, Oxford, United Kingdom
Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Oxford University, Oxford, United Kingdom
Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom
Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
University Centre Varazdin, University North, Varazdin, Croatia
University of Texas Health Science Center, Houston, TX, United States
Department of Mathematics and Sciences, Ajman University, Ajman, United Arab Emirates
Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
Center for Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ho, Ghana
Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran
Noncommunicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
Neurosicence Institute, Tehran University of Medical Sciences, Tehran, Iran
Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
Department of Nursing, Al Zaytoonah University of Jordan, Amman, Jordan
Department of Clinical Pharmacy and Practice, Qatar University, Doha, Qatar
Academic Health System, Hamad Medical Corporation, Doha, Qatar
Department of Therapeutics, United Arab Emirates University, Al Ain, United Arab Emirates
College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
College of Pharmacy, University of Jordan, Amman, Jordan
Department of Biochemistry and Molecular Medicine, Alfaisal University, Riyadh, Saudi Arabia
College of Graduate Health Sciences, University of Tennessee, Memphis, TN, United States
Chiang Rai Prachanukroh Hospital, Ministry of Public Health, Chiang Rai, Thailand
School of Medicine, University of Sydney, Sydney, NSW, Australia
Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
Sydney Medical School, University of Sydney, Sydney, NSW, Australia
School of Chemical & Biomolecular Engineering, University of Sydney, Sydney, NSW, Australia
Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia
University of Sydney, Sydney, NSW, Australia
Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
School of Population Health, University of New South Wales, Sydney, NSW, Australia
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States
Department of Pharmacology and Therapeutics, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Microbiology, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Biosciences and Biotechnology, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
Department of Veterinary Public Health and Preventive Medicine, Universitas Padjadjaran (Padjadjaran University), Bandung, Indonesia
Department of Public Health, Universitas Padjadjaran (Padjadjaran University), Bandung, Indonesia
Department of Life Sciences, University of Management and Technology, Lahore, Pakistan
Department of Community Medicine, King Edward Memorial Hospital, Lahore, Pakistan
Department of Public Health, Public Health Institute, Lahore, Pakistan
Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
Department of Medical Biochemistry, Shaqra University, Shaqra, Saudi Arabia
Department of Health and Biological Sciences, Abasyn University, Peshawar, Pakistan
Department of Natural Sciences, Lebanese American University, Beirut, Lebanon
School of Public Health, Zhejiang University, Hangzhou, China
Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
Community-Oriented Nursing Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Medical Education, University of Khartoum, Khartoum, Sudan
Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
Unit of Basic Medical Sciences, University of Khartoum, Khartoum, Sudan
Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
Department of Paediatric Infectious Diseases, University of Basel, Basel, Switzerland
Department of Biosciences, COMSATS Institute of Information Technology, Islamabad, Pakistan
Research and Development Department, Islamabad, Pakistan
Alpha Genomics Private Limited, Islamabad, Pakistan
Microbiological Analysis Team, Korea Research Institute of Standards and Science (KRISS), Daejeon, South Korea
Department of Medical Microbiology, Haramaya University, Harar, Ethiopia
Department of Public Health, Haramaya University, Harar, Ethiopia
Department of Biological Sciences, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
Brody School of Medicine, East Carolina University, Greenville, NC, United States
Department of Cardiology, Fudan University, Shanghai, China
Department of Communicable Diseases, Ministry of Health, Muscat, Oman
Middle East, Eurasia, and Africa Influenza Stakeholders Network, Muscat, Oman
Faculty of Pharmacy, Philadelphia University, Amman, Jordan
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School of Pharmacy, Cardiff University, Cardiff, United Kingdom
Faculty of Medicine, Yarmouk University, Irbid, Jordan
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, United States
Global Centre for Environmental Remediation, University of Newcastle, Newcastle, NSW, Australia
Cooperative Research Centre for Contamination Assessment and Remediation of the Environment, Newcastle, NSW, Australia
Africa Center of Excellence for Mycotoxin and Food Safety, Minna, Nigeria
Department of Zoology, Abdul Wali Khan University Mardan, Mardan, Pakistan
Center for Biotechnology and Microbiology, University of Swat, Swat, Pakistan
Department of Geography, Sultan Qaboos University, Muscat, Oman
Institute for Global Health, University College London, London, United Kingdom
Medical Research Council Clinical Trials Unit (MRC CTU), University College London, London, United Kingdom
Center for Clinical Microbiology, University College London, London, United Kingdom
Department of Dentistry, Sanaa University, Sanaa, Yemen
Irbid, Jordan
Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, Pakistan
Research Centre for Health Sciences (RCHS), The University of Lahore, Lahore, Pakistan
Research, Policy, and Training Directorate, Jordan Center for Disease Control, Amman, Jordan
Applied Science Research Center, Applied Science Private University, Amman, Jordan
Department of Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
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Division of Infectious Disease and Geographic Medicine, Stanford University, Stanford, CA, United States
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Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
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All India Institute of Medical Sciences, Bhubaneswar, India
Regenerative Medicine, Organ Procurement and Transplantation Multi-Disciplinary Center, Guilan University of Medical Sciences, Rasht, Iran
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Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
Department of Pediatrics, Al Ain University, Abu Dhabi, United Arab Emirates
College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
College of Art and Science, Ottawa University, Surprise, AZ, United States
School of Life Sciences, Arizona State University, Tempe, AZ, United States
Department of Veterinary Pharmacology and Toxicology, University of Ilorin, Ilorin, Nigeria
Department of Veterinary Physiology and Biochemistry, University of Ilorin, Ilorin, Nigeria
Department of Veterinary Public Health and Preventive Medicine, University of Ilorin, Ilorin, Nigeria
Institute for Biomedical Problems, Russian Academy of Sciences, Moscow, Russian Federation
Microbiology Laboratory, Vientiane, Laos
Department of Microbiology, Vientiane, Laos
Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Laos
Department of Medical Laboratory Sciences, University of Nigeria Nsukka, Enugu, Nigeria
Department of Telemedicine, Society for Disease Prevention, Inc, Hummelstown, PA, United States
Department of Immunology, Zanjan University of Medical Sciences, Zanjan, Iran
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Department of Surgery, Washington University in St Louis, St Louis, MO, United States
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
Department of Biological Sciences, London School of Hygiene & Tropical Medicine, London, United Kingdom
London School of Hygiene & Tropical Medicine, London, United Kingdom
Department of Applied Mathematics, Stellenbosch University, Stellenbosch, South Africa
Institute of Biotechnology and Genetic Engineering, The University of Agriculture, Peshawar, Pakistan
Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, United States
Faculty of Medicine, October 6 University, 6th of October City, Egypt
Department of Cardiology, October 6 University, 6th of October City, Egypt
Fondation Merieux, Lyon, France
Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
International Medical School, Management and Science University, Alam, Malaysia
Department of Pharmacology, Clinical Pharmacology and Toxicology, University of Belgrade, Belgrade, Serbia
Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Department for Clinical Pharmacology, University Children Hospital, Belgrade, Serbia
Department of Medicine, University of Cambridge, Cambridge, United Kingdom
Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge, Cambridge, United Kingdom
University of Cambridge, Cambridge, United Kingdom
Miller School of Medicine, University of Miami, Miami, FL, United States
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World Health Organization, Geneva, Switzerland
Department of Academics, Indian Institute of Public Health, Gurgaon, India
Department of Surgery, Jimma University, Jimma, Ethiopia
Department of Medical Laboratory Science, Wollo University, Dessie, Ethiopia
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Department of Biomedical Sciences, University of West Attica, Athens, Greece
National AIDS Reference Center of Southern Greece, University of West Attica, Athens, Greece
School of Public Health, University of West Attica, Athens, Greece
Centre for Clinical Research, Nairobi, Kenya
Kenya Medical Research Institute, Nairobi, Kenya
Department of Public Health, North Dakota State University, Fargo, ND, United States
Global Health Neurology Lab, NSW Brain Clot Bank, Sydney, NSW, Australia
Division of Cerebrovascular Medicine and Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
Department of Health Administration, Rutgers University, New Brunswick, NJ, United States
Institute for Infection and Immunity, St Georges University of London, London, United Kingdom
Centre for Neonatal and Paediatric Infection, St Georges University of London, London, United Kingdom
Department of Epidemiology and Evidence-Based Medicine, IM Sechenov First Moscow State Medical University, Moscow, Russian Federation
HCAI, Fungal, AMR, AMU, & Sepsis Division, United Kingdom Health Security Agency, London, United Kingdom
Department of Infection, Imperial College London, London, United Kingdom
Department of Surgery and Cancer, Imperial College London, London, United Kingdom
Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS (Agostino Gemelli University Polyclinic IRCCS), Rome, Italy
Global Health Research Institute, Università Cattolica del Sacro Cuore (Catholic University of Sacred Heart), Rome, Italy
School of Pharmacy, The University of Jordan, Amman, Jordan
Department of Pediatrics, University of São Paulo, Ribeirao Preto, Brazil
Department of Pediatrics, Clinical Hospital of Ribeirão Preto, Ribeirão Preto, Brazil
Colombian National Health Observatory, Instituto Nacional de Salud (National Institute of Health), Bogota, Colombia
Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia
Department of Public Health, National University of Colombia, Bogota, Colombia
College of Public Health, Medical, and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
Department of Public Health, University of Mataram, Mataram, Indonesia
Non-communicable Diseases Division, National Institute of Epidemiology, Chennai, India
State Disease Investigation Laboratory, Animal Resources Development Department, Agartala, India
Department of Clinical Nutrition, Jazan University, Jazan, Saudi Arabia
Department of Epidemiology, Jazan University, Jazan, Saudi Arabia
Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia
Department of Pediatrics, The Childs Trust Medical Research Foundation (CTMRF), Chennai, India
Microbiology Laboratory, Ministry of Health, Vientiane, Laos
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Sawangi, India
Department of Biology, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA, United States
Centre for Research Impact & Outcome, Chitkara University, Rajpura, India
Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Center for Biomedicine and Community Health, International School, Vietnam National University Hanoi (VNUIS), Hanoi, Viet Nam
School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
Department of Diagnostic and Therapeutic Technologies, Cooperativa de Ensino Superior Politécnico e Universitário (Polytechnic and University Higher Education Cooperative), Vila Nova de Famalicão, Portugal
Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
Associate Laboratory Institute for Health and Bioeconomy (i4HB), University of Porto, Porto, Portugal
Faculty of Engineering, University of Porto, Porto, Portugal
School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
Center for International Health (CIH), University of Bergen, Bergen, Norway
Bergen Center for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
Department of Biochemistry, Ministry of Health and Welfare, New Delhi, India
Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, India
Faculty of Science, National Autonomous University of Mexico, Mexico City, Mexico
Sydney Institute of Infectious Diseases, Sydney, NSW, Australia
Laboratoire National de Biologie Clinique et de Santé (National Laboratory of Clinical Biology and Health), Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population), Bangui, Central African Republic
Department of Social Medicine and Health Care Organisation, Medical University of Varna, Varna, Bulgaria
Department of Microbiology and Virology, Medical University of Varna, Varna, Bulgaria
South Plainfield, NJ, United States
Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
Department of Pharmaceutical Regulatory Affairs and Management, Manipal Academy of Higher Education, Manipal, India
Manipal Academy of Higher Education, Manipal, India
Department of Forensic Medicine and Toxicology, Kasturba Medical College Mangalore, Mangalore, India
Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
Department of Conservative Dentistry with Endodontics, Medical University of Silesia, Katowice, Poland
Department of Infectious Disease Epidemiology, Berlin, Germany
Robert Koch Institute, Berlin, Germany
Higher School of Technology, Sultan Moulay Slimane University, Beni Mellal, Morocco
Department of Biochemistry, Ege University, Izmir, Turkey
Azerbaijan State University of Economics (UNEC), Baku, Azerbaijan
Biomedical Informatics and Medical Statistics Department, Alexandria University, Alexandria, Egypt
Tropical Health Department, Alexandria University, Alexandria, Egypt
Faculty of Medicine, University of Tripoli, Tripoli, Libya
Houston Methodist Hospital, Houston, TX, United States
Infection Prevention and Control Unit, Hospices Civils de Lyon, Lyon, France
REA-REZO, Hospices Civils de Lyon, Lyon, France
Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID), Centre International de Recherche en Infectiologie (CIRI), Lyon, France
Research and Development Department, Geneva, Switzerland
Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
Deanery of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
Global Health Governance Programme, University of Edinburgh, Edinburgh, United Kingdom
Department of Infectious Diseases and Public Health, City University of Hong Kong, Hong Kong
Department of Public Health and Infectious Diseases, City University of Hong Kong, Hong Kong
Department of Animal Medicine, Zagazig University, Zagazig, Egypt
Department of Pediatrics, Texas A&M University, Dallas, TX, United States
Department of Bacteriology and Virology, Semnan University of Medical Sciences, Semnan, Iran
Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
Department of Anesthesia, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, United States
Department of Biotechnology, University of the Western Cape, Cape Town, South Africa
School of Pharmacy, University of the Western Cape, Cape Town, South Africa
Research Centre for Healthcare and Community, Coventry University, Coventry, United Kingdom
Department of Oral Biology, Riphah International University, Islamabad, Pakistan
Department of Food Hygiene and Quality Control, University of Tehran, Tehran, Iran
Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria, South Africa
Animal Production and Health Division (EMPRES), Food and Agriculture Organization of the United Nations, Rome, Italy
Institute of International Health, Charité Universitätsmedizin Berlin (Charité Medical University Berlin), Berlin, Germany
Institute of Public Health, Charité Universitätsmedizin Berlin (Charité Medical University Berlin), Berlin, Germany
Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin (Charité Medical University Berlin), Berlin, Germany
Department of Environmental Health Engineering, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
Bacteria and Drug Resistant Infections Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
Department of Pharmacy, Wollega University, Nekemte, Ethiopia
Department of Pharmacology, Gadjah Mada University, Yogyakarta, Indonesia
Clinical Services Department, Medical Research Council Unit, The Gambia, Fajara, Gambia
Department of Community Medicine, Bayero University Kano, Kano, Nigeria
Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
Department of Oral Biology and Experimental Dental Research, University of Szeged, Szeged, Hungary
Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Nagpur, India
Unisabana Center for Translational Science, Universidad de La Sabana (Savannah University), Chia, Colombia
Applied Epidemiology Program, Sabin Vaccine Institute, Washington, DC, United States
Department of Pharmacology, Indore Institute of Pharmacy, Indore, India
Department of Midwifery, Adigrat University, Adigrat, Ethiopia
Department of Medical Laboratory Sciences, Adigrat University, Adigrat, Ethiopia
Department of Reproductive and Family Health, Axum College of Health Science, Axum, Ethiopia
College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
Hellenic National Public Health Organization, Athens, Greece
Family and Community Medicine Department, King Khalid University Hospital, Abha, Saudi Arabia
Department of Health Systems and Policy Research, Indian Institute of Public Health, Gandhinagar, India
Department of Life Sciences, Health and Healthcare Professions, Link Campus University, Rome, Italy
Health Services Research, Evaluation and Policy Unit, AUSL della Romagna, Ravenna, Italy
Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
Department of Thoracic Surgery, Cleveland Clinic, Cleveland, OH, United States
Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
Centre for Noncommunicable Diseases and Nutrition, BRAC University, Dhaka, Bangladesh
Department of Toxicology, Shriram Institute for Industrial Research, Delhi, India
School of Biotechnology, Dublin City University, Dublin, Ireland
Department of Public Health, Charité Institute of Public Health, Berlin, Germany
Medical Research Unit, Universitas Syiah Kuala (Syiah Kuala University), Banda Aceh, Indonesia
Sydney Infectious Diseases Institute, Sydney, NSW, Australia
Department of Zoology and Entomology, Al-Azhar University, Cairo, Egypt
Department of Pharmaceutical Technology, University of Dhaka, Dhaka, Bangladesh
Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
Interventions and Implementation Research Department, Seoul, South Korea
Epidemiology and Public Health Research Department, Seoul, South Korea
Epidemiology, Public Health, Impact Unit (EPIC), Seoul, South Korea
International Vaccine Institute, Seoul, South Korea
Department of Pharmacy, Palamau Institute of Pharmacy, Daltonganj, India
Public Health Department, Dalhatu Araf Specialist Hospital, Lafia, Nigeria
Department of Public Health, Federal University of Lafia, Lafia, Nigeria
Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
Department of Pharmacy Administration and Clinical Pharmacy, Xian Jiaotong University, Xian, China
Department of Microbiology, Taiz University, Taiz, Yemen
School of Medicine, Nankai University, Tianjin, China
Department of Decision and Information Sciences, University of Houston, Houston, TX, United States
Public Health Research Group, Nature Study Society of Bangladesh, Khulna, Bangladesh
Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam
Department of Computer Science, University of Human Development, Sulaymaniyah, Iraq
Department of Clinical Legal Medicine, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
Department of Biomolecular Sciences, University of Zakho, Zakho, Iraq
College of Health Sciences, VinUniversity, Hanoi, Viet Nam
School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
Critical Care Department, Clinica Universidad De La Sabana (Savannah University Clinic), Chia, Colombia
Clinica Universidad De La Sabana (Savannah University Clinic), Chia, Colombia
The National Centre for Remote and Rural Health and Care, NHS National Services Scotland, Edinburgh, United Kingdom
Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
Clinical Laboratory Department, Tobruk University, Tobruk, Libya
Department of Blood Transmitted Diseases, National Centre for Disease Control (NCDC), Tobruk, Libya
Department of Clinical Pharmacy & Pharmacy Practice, Asian Institute of Medicine, Science and Technology, Bedong, Malaysia
Malaysian Academy of Pharmacy, Puchong, Malaysia
Department of Global Health, South African Medical Research Council, Cape Town, South Africa
Department of Global Health, Stellenbosch University, Cape Town, South Africa
Department of Immunology, Kerman University of Medical Sciences, Kerman, Iran
HIV/STI Surveillance Research Center, Kerman University of Medical Sciences, Kerman, Iran
Department of Immunology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Clinical Services Department, Medical Research Counci

Institute for Health Metrics and Evaluation
Department of Health Metrics Sciences
Department of Pediatrics
Department of Applied Mathematics
School of Health Systems and Public Health
Department of Biostatistics
Department of Global Health
Department of Pharmacy
GBD Collaborating Unit
Norwegian Institute of Public Health
Division of Infectious Diseases
Nuffield Department of Medicine
Big Data Institute
The Global Research on Antimicrobial Resistance Project
Nuffield Department of Population Health
Centre for Tropical Medicine and Global Health
International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC)
Nuffield Department of Clinical Medicine
Oxford Vaccine Group
University Centre Varazdin
University of Texas Health Science Center
Department of Mathematics and Sciences
Department of Clinical Sciences
Center for Medical and Bio-allied Health Sciences Research
Department of Tropical Medicine and Infectious Diseases
Department of Family and Community Health
Department of Epidemiology and Biostatistics
Research Center for Immunodeficiencies
Noncommunicable Diseases Research Center
Neurosicence Institute
Iranian Research Center for HIV/AIDS (IRCHA)
Sina Trauma and Surgery Research Center
Department of Neurology
Research Center for Rational Use of Drugs
Department of Medical Biochemistry and Biophysics
Department of Nursing
Department of Clinical Pharmacy and Practice
Academic Health System
Department of Therapeutics
College of Medicine and Health Sciences
College of Pharmacy
Department of Biochemistry and Molecular Medicine
College of Graduate Health Sciences
Chiang Rai Prachanukroh Hospital
School of Medicine
Faculty of Medicine
Sydney Medical School
School of Chemical & Biomolecular Engineering
Sydney Institute for Infectious Diseases
University of Sydney
Centre for Social Research in Health
School of Population Health
Department of Obstetrics and Gynecology
Department of Pharmacology and Therapeutics
Department of Microbiology
Department of Biosciences and Biotechnology
Department of Veterinary Medicine
Department of Epidemiology and Medical Statistics
Department of Veterinary Public Health and Preventive Medicine
Department of Public Health
Department of Life Sciences
Department of Community Medicine
Department of Public Health
Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia
Department of Medical Biochemistry
Department of Health and Biological Sciences
Department of Natural Sciences
School of Public Health
Department of Epidemiology and Biostatistics
Community-Oriented Nursing Midwifery Research Center
Department of Epidemiology
Social Determinants of Health Research Center
Department of Medical Education
Institute of Endemic Diseases
Unit of Basic Medical Sciences
Swiss Tropical and Public Health Institute
Department of Paediatric Infectious Diseases
Department of Biosciences
Research and Development Department
Alpha Genomics Private Limited
Microbiological Analysis Team
Department of Medical Microbiology
Department of Public Health
Department of Biological Sciences
Brody School of Medicine
Department of Cardiology
Department of Communicable Diseases
Middle East
Faculty of Pharmacy
Faculty of Nursing
School of Pharmacy
Faculty of Medicine
Division of Gastroenterology and Hepatology
Global Centre for Environmental Remediation
Cooperative Research Centre for Contamination Assessment and Remediation of the Environment
Africa Center of Excellence for Mycotoxin and Food Safety
Department of Zoology
Center for Biotechnology and Microbiology
Department of Geography
Institute for Global Health
Medical Research Council Clinical Trials Unit (MRC CTU)
Center for Clinical Microbiology
Department of Dentistry
Irbid
Department of Allied Medical Sciences
Department of Clinical Pharmacy
Department of Public Health
Institute of Molecular Biology and Biotechnology
Research Centre for Health Sciences (RCHS)
Research
Applied Science Research Center
Department of Specialty Internal Medicine
Department of Medicine
Department of Pharmacy Practice and Pharmacotherapeutics
Clinical Sciences Department
Department of Basic Biomedical Sciences
Department of Basic Medical Sciences
College of Medicine
Department of Medicinal Chemistry
Department of Biomedical Engineering
Infectious Diseases Surveillance
Infectious Diseases Research Collaboration (IDRC)
Department of Global Health
Kumasi Center for Collaborative Research in Tropical Medicine
Faculty of Pharmacy
Department of Legal Medicine and Bioethics
Department of General Surgery
Department of Anatomy and Embryology
Division of Infectious Disease and Geographic Medicine
Department of Medicine
Department of Radiology
Department of Pharmacology
Department of Community Medicine and Family Medicine
Department of Pharmacology and Research
All India Institute of Medical Sciences
Regenerative Medicine
Department of Social Medicine and Epidemiology
Rural Health Research Institute
School of Medicine and Public Health
Inter-Agency Committee on Environmental Health
Health Management and Economics Research Center
School of Medicine
Preventive Medicine and Public Health Research Center
Department of Ophthalmology
Research Center of Pediatric Infectious Diseases
Department of Pediatrics
College of Pharmacy
College of Art and Science
School of Life Sciences
Department of Veterinary Pharmacology and Toxicology
Department of Veterinary Physiology and Biochemistry
Department of Veterinary Public Health and Preventive Medicine
Institute for Biomedical Problems
Microbiology Laboratory
Department of Microbiology
Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU)
Department of Medical Laboratory Sciences
Department of Telemedicine
Department of Immunology
Department of Medical Laboratory Sciences
Department of Medical Microbiology
Department of Pharmacology
Department of Surgery
Department of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases
Department of Biological Sciences
London School of Hygiene & Tropical Medicine
Department of Applied Mathematics
Institute of Biotechnology and Genetic Engineering
Montefiore-Einstein Cerebrovascular Research Lab
Faculty of Medicine
Department of Cardiology
Fondation Merieux
Gomal Center of Biochemistry and Biotechnology
International Medical School
Department of Pharmacology
Faculty of Medicine
Department for Clinical Pharmacology
Department of Medicine
Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID)
University of Cambridge
Miller School of Medicine
Department of Public Health Sciences
World Health Organization
Department of Academics
Department of Surgery
Department of Medical Laboratory Science
Department of Environmental Health
Department of Biomedical Sciences
National AIDS Reference Center of Southern Greece
School of Public Health
Centre for Clinical Research
Kenya Medical Research Institute
Department of Public Health
Global Health Neurology Lab
Division of Cerebrovascular Medicine and Neurology
Department of Health Administration
Institute for Infection and Immunity
Centre for Neonatal and Paediatric Infection
Department of Epidemiology and Evidence-Based Medicine
HCAI
Department of Infection
Department of Surgery and Cancer
Department of Primary Care and Public Health
Department of Woman and Child Health and Public Health
Global Health Research Institute
School of Pharmacy
Department of Pediatrics
Department of Pediatrics
Colombian National Health Observatory
Epidemiology and Public Health Evaluation Group
Department of Public Health
College of Public Health
Department of Public Health
Non-communicable Diseases Division
State Disease Investigation Laboratory
Department of Clinical Nutrition
Department of Epidemiology
Substance Abuse and Toxicology Research Center
Department of Pediatrics
Microbiology Laboratory
Temerty Faculty of Medicine
Department of Community Medicine
Department of Biology
Division of Infectious Diseases
Centre for Research Impact & Outcome
Department of Internal Medicine
Center for Biomedicine and Community Health
School of Nursing and Midwifery
Department of Diagnostic and Therapeutic Technologies
Institute for Research and Innovation in Health (i3S)
Associate Laboratory Institute for Health and Bioeconomy (i4HB)
Faculty of Engineering
School of Nursing
Department of Global Public Health and Primary Care
Center for International Health (CIH)
Bergen Center for Ethics and Priority Setting (BCEPS)
Department of Biochemistry
Department of Implementation Research
Department of Infectious Disease Epidemiology
Division of Pathology
Faculty of Science
Sydney Institute of Infectious Diseases
Laboratoire National de Biologie Clinique et de Santé (National Laboratory of Clinical Biology and Health)
Department of Social Medicine and Health Care Organisation
Department of Microbiology and Virology
South Plainfield
Kasturba Medical College Mangalore
Department of Pharmaceutical Regulatory Affairs and Management
Manipal Academy of Higher Education
Department of Forensic Medicine and Toxicology
Mahidol Oxford Tropical Medicine Research Unit
Department of Conservative Dentistry with Endodontics
Department of Infectious Disease Epidemiology
Robert Koch Institute
Higher School of Technology
Department of Biochemistry
Azerbaijan State University of Economics (UNEC)
Biomedical Informatics and Medical Statistics Department
Tropical Health Department
Faculty of Medicine
Houston Methodist Hospital
Infection Prevention and Control Unit
REA-REZO
Public Health
Research and Development Department
Global Antibiotic Research and Development Partnership (GARDP)
Deanery of Biomedical Sciences
Global Health Governance Programme
Department of Infectious Diseases and Public Health
Department of Public Health and Infectious Diseases
Department of Animal Medicine
Department of Pediatrics
Department of Bacteriology and Virology
Cancer Research Center
Department of Anesthesia
Department of Biotechnology
School of Pharmacy
Research Centre for Healthcare and Community
Department of Oral Biology
Department of Food Hygiene and Quality Control
Department of Veterinary Tropical Diseases
Animal Production and Health Division (EMPRES)
Institute of International Health
Institute of Public Health
Institute of Hygiene and Environmental Medicine
Department of Environmental Health Engineering
Department of Clinical Sciences
Bacteria and Drug Resistant Infections Group
Department of Pharmacy
Department of Pharmacology
Clinical Services Department
Department of Community Medicine
Department of Community Medicine
Department of Oral Biology and Experimental Dental Research
Department of Community Medicine and Family Medicine
Unisabana Center for Translational Science
Applied Epidemiology Program
Department of Pharmacology
Department of Midwifery
Department of Medical Laboratory Sciences
Department of Reproductive and Family Health
College of Medicine and Public Health
Hellenic National Public Health Organization
Family and Community Medicine Department
Department of Health Systems and Policy Research
Department of Life Sciences
Health Services Research
Institute of Infection
Department of Thoracic Surgery
Lerner Research Institute
Department of Epidemiology and Biostatistics
Centre for Noncommunicable Diseases and Nutrition
Department of Toxicology
School of Biotechnology
Department of Public Health
Medical Research Unit
Sydney Infectious Diseases Institute
Department of Zoology and Entomology
Department of Pharmaceutical Technology
Department of Pathology and Laboratory Medicine
Department of Paediatrics and Child Health
Interventions and Implementation Research Department
Epidemiology and Public Health Research Department
Epidemiology
International Vaccine Institute
Department of Pharmacy
Public Health Department
Department of Public Health
Institute of Pharmaceutical Sciences
Department of Pharmacy Administration and Clinical Pharmacy
Department of Microbiology
School of Medicine
Department of Decision and Information Sciences
Public Health Research Group
Institute of Research and Development
Department of Computer Science
Department of Clinical Legal Medicine
Department of Biomolecular Sciences
College of Health Sciences
School of Health Care Administration
Critical Care Department
Clinica Universidad De La Sabana (Savannah University Clinic)
The National Centre for Remote and Rural Health and Care
Institute for Physical Activity and Nutrition
Clinical Laboratory Department
Department of Blood Transmitted Diseases
Department of Clinical Pharmacy & Pharmacy Practice
Malaysian Academy of Pharmacy
Department of Global Health
Department of Global Health
Department of Immunology
HIV/STI Surveillance Research Center
Department of Immunology
Clinical Services Department

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