{
  "abstract": "Carbapenem-resistant Gram-negative infections are a global threat, yet their long-term pathogen-specific mortality dynamics and pandemic-era deviations remain unclear. In this secondary modelling analysis, we evaluate associated mortality under a no-infection counterfactual and attributable mortality under a drug-susceptible infection counterfactual for carbapenem-resistant Gram-negative infections overall and across seven constituent pathogen groups in 204 countries and territories from 1990 to 2021. Using age-period-cohort decomposition and Bayesian counterfactual modelling, we estimate 1.03 million associated (95% uncertainty interval, 0.90–1.17 million) and 0.22 million attributable (0.17–0.27 million) deaths from these infections in 2021. From 1990 to 2019, overall associated and attributable mortality rates increased by 0.82% (95% confidence interval, 0.77–0.87) and 0.90% (0.85–0.95) per year, respectively. South Asia has the fastest-rising associated and attributable mortality, whereas high-income regions decline. Among constituent pathogens, Klebsiella pneumoniae shows the fastest increase in mortality rates, while Pseudomonas aeruginosa shows declining associated but slightly rising attributable mortality. During 2020–2021, overall associated mortality falls 4.71% below pre-pandemic counterfactual projections, whereas attributable mortality does not change significantly. Here, we show divergent mortality trajectories by region, pathogen, and metric, motivating targeted, dual-metric surveillance and intervention strategies.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China",
    "Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China",
    "Shanghai Sci-Tech Inno Center for Infection & Immunity, Shanghai, China",
    "Department of Science and Education, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, China",
    "Department of Neurocritical care unit, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China",
    "Department of Infectious Diseases, Taicang First People’s Hospital, Taicang, China",
    "Department of Infection Control, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China",
    "Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China",
    "Department of Intensive Care Unit, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China",
    "Institute of Infection and Health, Fudan University, Shanghai, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Zhihui Chen"
    },
    {
      "affs": [
        3
      ],
      "name": "Mingchen Zhong"
    },
    {
      "affs": [
        0
      ],
      "name": "Jing Wu"
    },
    {
      "affs": [
        4
      ],
      "name": "Xiangru Ye"
    },
    {
      "affs": [
        0,
        5
      ],
      "name": "Zhonghua Li"
    },
    {
      "affs": [
        6
      ],
      "name": "Jing Wang"
    },
    {
      "affs": [
        7
      ],
      "name": "Yueru Tian"
    },
    {
      "affs": [
        7
      ],
      "name": "Shirong Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Lei Zhou"
    },
    {
      "affs": [
        8
      ],
      "name": "Jie Ni"
    },
    {
      "affs": [
        0
      ],
      "name": "Jialin Jin",
      "orcid": "0000-0002-9134-5228"
    },
    {
      "affs": [
        0,
        2,
        9
      ],
      "name": "Wenhong Zhang",
      "orcid": "0000-0002-1246-0747"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fb7dzw3d8bthh.bib",
  "cited_by": 0,
  "doi": "10.1038/s41467-026-77197-6",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13710958/",
  "id": "fb7dzw3d8bthh",
  "issns": [
    "2041-1723"
  ],
  "landing_url": "https://doi.org/10.1038/s41467-026-77197-6",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Article"
    ],
    [
      "openalex",
      "1313|Antibiotic Resistance in Bacteria"
    ]
  ],
  "openalex": "W7214422055",
  "pdf_url": "https://www.nature.com/articles/s41467-026-77197-6_reference.pdf",
  "pmcid": "PMC13710958",
  "pmid": "42934241",
  "published": "2026-09-26",
  "publisher": "Nature Publishing Group",
  "ris": "https://research.draconitic.com/paper/fb7dzw3d8bthh.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:21:49Z",
      "native_id": "PMC13710958",
      "source": "pmc",
      "url": "https://doi.org/10.1038/s41467-026-77197-6"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:1313|Antibiotic Resistance in Bacteria",
      "subfield": "general"
    }
  ],
  "title": "Global spatiotemporal dynamics of mortality from carbapenem-resistant Gram-negative infections over the past three decades",
  "title_text": "Global spatiotemporal dynamics of mortality from carbapenem-resistant Gram-negative infections over the past three decades",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:21:49Z",
  "url": "https://research.draconitic.com/paper/fb7dzw3d8bthh",
  "venue": "Nature Communications",
  "versions": []
}