Study highlights ‘substantial’ burden of drug-resistant hospital infections in Asia
Chris Dall, MAToday at 2:41 p.m.
Antimicrobial Stewardship
Pneumonia
A large multinational study suggests the burden of drug-resistant hospital infections in Asia is “substantial and likely underestimated,” particularly in the region’s low- and middle-income countries (LMICs).
The study, published late last week in The Lancet Infectious Diseases, found that deaths from ventilator-associated pneumonia and bloodstream infections, which are two of the most severe types of healthcare-associated infection (HAI), are significantly higher than previously reported—roughly twice as high as previous estimates.
For the prospective study, a team led by researchers with the National University of Singapore analyzed data on nearly 10,000 patients treated for ventilator-associated pneumonia and hospital-acquired bloodstream infections at 41 hospitals in 19 Asian countries and regions. Their aim was to characterize resistance profiles, clinical outcomes, and mortality attributable to antimicrobial resistance (AMR).
While Asian countries are known to have high rates of antibiotic consumption and AMR, most estimates on the impact of drug-resistant infections in the region have relied on modeling assumptions based on aggregated population-level data and pathogen resistance rates, the study authors note. Among those is the 2019 Global Research on Antimicrobial Resistance study, published in 2022, which estimated that 130,000 deaths in Asia could be directly attributed to drug-resistant ventilator-associated pneumonia and bloodstream infections.
This is the largest study from Asia to link microbiologic resistance data with clinical outcomes for the two HAIs.
“In many Asian countries, constrained laboratory capacity, limited antimicrobial stewardship, and inconsistent regulatory oversight prohibit the implementation of multinational, standardised prospective AMR surveillance,” the study authors wrote. “To address these important gaps, we established ACORN-HAI, which is a multicentre, patient-focused AMR and health-care-associated infection surveillance network in Asia.”
38% death rate for resistant infections
Of the 10,111 patients enrolled in the study from September 2022 through February 2025, 9,496 were included in the final analysis. The 9,642 infection episodes analyzed included 6,597 bloodstream infections and 3,045 cases of ventilator-associated pneumonia.Nearly three-quarters (73.7%) of the infections were associated with drug-resistant bacteria, primarily gram-negative pathogens, of which 62% were multidrug-resistant (MDR). The crude 28-day morality rate was 38% for patients with resistant infections and 41% for those with MDR infections, with the highest mortality rates found in patients with carbapenem-resistant Acinetobacter (51%) and carbapenem-resistant Enterobacterales (49%) infections.
After adjustments were made for baseline patient characteristics, the attributable mortality for AMR infections was highest in patients with ventilator-associated pneumonia (17%), among children aged 5 to 14 years (12%) and adults aged 15 to 49 years (11%), and in patients in low- and middle-income countries (11%). Estimates in high-income countries suggested little or no mortality difference between resistant and susceptible infections, the authors note.
Overall, an estimated that 250,000 deaths were attributable to AMR ventilator-associated pneumonia and bloodstream infections.
“Although our estimates were derived from selected hospitals and might not be nationally representative, these differences suggest that modelling approaches relying on assumptions to link microbiology and patient outcome data might underestimate the burden of health-care-associated AMR, particularly in LMIC settings,” the authors wrote.
Analysis of antibiotic treatment patterns revealed that most carbapenem-resistant infections were treated with carbapenem or polymyxin antibiotics, a finding the authors say likely reflects restricted access to, or complete unavailability of, newer antibiotics that target carbapenem-resistant pathogens.
“The widespread use of suboptimal antimicrobial regimens highlights the urgent need for equitable access to effective therapies and context-specific evidence to guide antimicrobial stewardship,” they wrote.
In an accompanying commentary, infectious disease experts from the University of Virginia School of Medicine and Universidad del Desarrollo in Chile say the study’s greatest contribution is its “accurate measurement of the real toll of AMR across a vast and diverse group of countries and settings.”
“As global efforts move from estimating the burden of AMR towards measuring it directly, studies such as ACORN-HAI will become indispensable,” Amy Mathers, MD, and Jose Munita, MD, wrote. “Better patient-level data produce better models, and better models can support better policy. The next challenge is to move past measuring the burden of AMR and determine whether closing the diagnostic and therapeutic gap improves survival of resistant infections.”