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Peer-reviewedCC BY-NC-ND 4.0Nature Communications

Global spatiotemporal dynamics of mortality from carbapenem-resistant Gram-negative infections over the past three decades

  • Zhihui Chen1,2,3
  • Mingchen Zhong4
  • Jing Wu1
  • Xiangru Ye5
  • Zhonghua Li1,6
  • Jing Wang7
  • Yueru Tian8
  • Shirong Li8
  • Lei Zhou1
  • Jie Ni9
  • Jialin Jin1
  • Wenhong Zhang1,3,10
10 affiliations
  1. 1Department 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
  2. 2Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
  3. 3Shanghai Sci-Tech Inno Center for Infection & Immunity, Shanghai, China
  4. 4Department of Science and Education, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, China
  5. 5Department of Neurocritical care unit, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
  6. 6Department of Infectious Diseases, Taicang First People’s Hospital, Taicang, China
  7. 7Department of Infection Control, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
  8. 8Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
  9. 9Department of Intensive Care Unit, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
  10. 10Institute of Infection and Health, Fudan University, Shanghai, China
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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.

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Cite

BibTeXRIS
BibTeX
@article{chen2026global,
  title = {{Global spatiotemporal dynamics of mortality from carbapenem-resistant Gram-negative infections over the past three decades}},
  author = {Zhihui Chen and Mingchen Zhong and Jing Wu and Xiangru Ye and Zhonghua Li and Jing Wang and Yueru Tian and Shirong Li and Lei Zhou and Jie Ni and Jialin Jin and Wenhong Zhang},
  journal = {Nature Communications},
  year = {2026},
  month = sep,
  doi = {10.1038/s41467-026-77197-6},
  url = {https://doi.org/10.1038/s41467-026-77197-6},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Global spatiotemporal dynamics of mortality from carbapenem-resistant Gram-negative infections over the past three decades
AU  - Zhihui Chen
AU  - Mingchen Zhong
AU  - Jing Wu
AU  - Xiangru Ye
AU  - Zhonghua Li
AU  - Jing Wang
AU  - Yueru Tian
AU  - Shirong Li
AU  - Lei Zhou
AU  - Jie Ni
AU  - Jialin Jin
AU  - Wenhong Zhang
PY  - 2026
DA  - 2026/09/26
JO  - Nature Communications
DO  - 10.1038/s41467-026-77197-6
UR  - https://doi.org/10.1038/s41467-026-77197-6
AB  - 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.
SN  - 2041-1723
ER  -