A new global analysis warns that antibiotic resistance is undermining decades of progress against lower respiratory infections (LRIs), including pneumonia and bronchiolitis. Using data from the Global Burden of Disease Study, researchers found that while overall LRI deaths fell from 4.3 million in 1990 to 3.5 million in 2021, drug-resistant infections now account for a growing share of fatalities.
In 2021, nearly half of all LRI deaths were linked to antibiotic-resistant bacteria — almost three times as many as those caused by drug-susceptible strains. Bacterial infections were responsible for more than 80% of LRI deaths, with leading pathogens including Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae.
Although mortality rates have declined overall, trends differ by age and region. Deaths have dropped significantly among children under five but increased in adults over 50. Low-income regions — particularly in sub-Saharan Africa — bear the heaviest burden, with substantially higher mortality rates from resistant infections.
Of particular concern is rising resistance to carbapenems, a last-resort class of antibiotics. As these treatments lose effectiveness, once-manageable infections risk becoming untreatable. The findings underscore antimicrobial resistance as a major global health threat and highlight the urgent need for stronger stewardship, improved surveillance, and expanded access to vaccines and new treatments.
