全球细菌感染负担分析——33种细菌病原体相关的全球死亡率（2019年）报告解读

doi:10.16150/j.1671-2870.2023.06.005

摘要/Abstract

摘要：

全球细菌感染负担报告显示，2019年全球因细菌感染相关死亡者约有1 370万人[95%（uncertainty intervals， UI）为1 090万~1 710万]，占同期全球死亡人数的13.6%（10.1%-18.1%），为全球第二大死亡原因，仅次于缺血性心脏病。11种感染性综合征中，33种细菌病原体与全球770万人（570万~1 020万）的死亡相关。下呼吸道感染导致全球约400万人（333万~489万）死亡，其中肺炎链球菌导致了最多死亡，为65.3万（55.3万~77.7万）；血流感染导致了291万人(174万~453万)，其中金黄色葡萄球菌导致了最多死亡，为29.9万人（16.6万~48.5万）；腹膜和腹腔内感染导致128万人（82.6万~186.0万）死亡,其中大肠埃希菌导致死亡最多，为29万人（18.8万~42.3万）。全球细菌感染负担报告还显示，2019年，金黄色葡萄球菌与超过100万人死亡相关(导致110.5万人死亡)；大肠埃希菌导致全球45万（32.9万~60.2万）女性和50万（35.5万~68.4万）男性死亡，肺炎链球菌导致全球超过75万人死亡；肺炎克雷伯菌导致全球超过75万人死亡；铜绿假单胞菌导致全球超过50万人死亡。全球细菌感染负担报告数据表明，在全球范围内，与死亡人数最多相关的病原体因年龄而异。金黄色葡萄球菌是15岁以上人群中死亡最多的病原体，该年龄组有94万人（68.2万~127.6万）死亡；伤寒沙门氏菌与5~14岁儿童死亡最多相关，死亡人数达4.9万人（2.3万~8.6万）；肺炎链球菌与新生儿至4岁幼儿死亡最多相关，死亡人数达22.5万人（18.0万~28.1万）。全球细菌感染负担报告通过估计各种病原体和感染性综合征的死亡率，这些细菌感染负担有些是之前未知的，有些是被严重低估的，特别是在中低收入国家中不成比例的高负担，而中国地区缺乏相应的数据及研究，有必要开展相应的调查研究，从而制定创新策略。

关键词: 感染性综合征, 细菌病原体, 死亡率, 寿命损失年

Abstract:

The Global Burden of Bacterial Infections report showed that in 2019, there were approximately 13.7 million deaths worldwide due to infection (95% UI ranging from 10.9 million to 17.1 million), and bacterial infection related deaths accounted for 13.6% (10.1%-18.1%) of global deaths, making it the second leading cause of death globally, second only to ischemic heart disease. Eleven infectious syndromes involve 33 bacterial pathogens and are associated with 7.7 million deaths worldwide (5.7 million to 10.2 million). Lower respiratory tract infections have caused approximately 4 million deaths worldwide (3.33 million to 4.89 million), with Streptococcus pneumoniae causing the most deaths at 653 000 (553 000 to 777 000); Blood flow infections have caused 2.91 million people (1.74 million to 4.53 million), with Staphylococcus aureus causing the most deaths, at 299 000 people (166 000 to 485 000); Peritoneal and intra-abdominal infections have caused 1.28 million deaths (826 000 to 1.86 million), with Escherichia coli causing the most deaths, reaching 290000 (188 000 to 423 000). The Global Burden of Bacterial Infections report also shows that in 2019, Staphylococcus aureus was associated with over 1 million deaths (resulting in 1.105 million deaths); Escherichia coli causes 450 000 (329 000 to 602 000) female and 500 000 (355 000 to 684 000) male deaths worldwide, while Streptococcus pneumoniae causes over 750 000 deaths worldwide; Klebsiella pneumoniae causes over 750 000 deaths worldwide; Pseudomonas aeruginosa has caused over 500 000 deaths worldwide. The Global Burden of Bacterial Infections report data shows that the pathogens most associated with mortality worldwide vary by age. Staphylococcus aureus is the deadliest pathogen among people aged 15 and above, with 940 000 deaths (682 000 to 1 276 000) in this age group; Salmonella typhi is most associated with mortality in children aged 5-14, with a death toll of 49 000 (23 000-86 000); Streptococcus pneumoniae is most associated with the death of newborns to 4-year-old children, with a death toll of 225 000 (180 000 to 281 000). The Global Burden of Bacterial Infections report estimates the mortality rates of various pathogens and infectious syndromes, some of which were previously unknown and some were severely underestimated, especially in low-and middle-income countries where the burden is disproportionately high. However, there is a lack of corresponding data and research in China, and it is necessary to conduct corresponding surveys and research to develop innovative strategies.

Key words: Infectious syndrome, Bacterial pathogens, Mortality rate, Life loss year

中图分类号:

R446.1
R515

仉英, 蒋晓飞. 全球细菌感染负担分析——33种细菌病原体相关的全球死亡率（2019年）报告解读[J]. 诊断学理论与实践, 2023, 22(06): 541-549.

ZHANG Ying, JIANG Xiaofei. Analysis of global burden of bacterial infections: an interpretation of Global mortality associated with 33 bacterial pathogens in 2019[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(06): 541-549.

图/表 4

表1

表2

表3

2019年按GBD超级地区分类的主要病原体死亡人数及主要感染性综合征

地区及感染类型	病原体
地区及感染类型	金黄色葡萄球菌	大肠埃希菌	肺炎链球菌	肺炎克雷伯菌	铜绿假单胞菌
东南亚、东亚和大洋洲
1类	9.45(5.25~15.60)	4.19(2.28~6.92)	2.86(1.58~4.65)	5.31(2.97~8.74)	4.43(2.44~7.24)
2类	8.09(6.25~10.50)	2.46(1.88~3.24)	12.00(9.58~15.00)	3.89(2.92~5.14)	4.24(2.94~6.03)
3类	4.00(2.40~6.15)	6.90(4.26~10.70)	-	3.64(2.27~5.54)	2.52(1.54~3.87)
中欧、东欧及中亚
1类	2.39(1.27~4.07)	3.83(2.01~6.57)	1.13(0.60~1.91)	1.75(0.94~2.97)	0.84(0.45~1.44)
2类	2.63(2.08~3.42)	0.56(0.43~0.74)	2.59(2.18~3.15)	0.93(0.71~1.25)	1.15(0.81~1.65)
3类	1.52(0.94~2.24)	2.57(1.65~3.73)	-	1.27(0.82~1.85)	0.98(0.63~1.44)
高收入超级地区
1类	9.18(4.89~15.40)	7.62(4.01~13.00)	1.88(1.00~3.15)	3.41(1.83~5.72)	2.12(1.14~3.56)
2类	13.70(11.40~16.30)	1.71(1.40~2.08)	7.08(6.01~8.23)	2.80(2.27~3.44)	4.31(3.35~5.60)
3类	3.16(2.05~4.62)	6.16(4.00~9.00)	-	2.81(1.85~4.11)	2.52(1.65~3.66)
拉丁美洲及加勒比海
1类	2.06(1.14~3.38)	1.74(0.94~2.90)	0.93(0.53~1.48)	2.05(1.17~3.29)	1.27(0.72~2.04)
2类	5.06(4.15~6.21)	1.15(0.91~1.46)	4.20(3.53~5.02)	1.93(1.51~2.45)	1.97(1.47~2.64)
3类	1.57(1.01~2.30)	2.70(1.84~3.84)	-	1.48(0.98~2.12)	0.94(0.62~1.36)
北非和中东
1类	1.56(0.85~2.54)	1.14(0.62~1.87)	0.73(0.41~1.19)	1.55(0.88~2.45)	0.98(0.54~1.56)
2类	2.66(2.09~3.40)	0.90(0.67~1.20)	3.21(2.58~3.95)	1.37(1.04~1.79)	1.23(0.90~1.68)
3类	1.00(0.59~1.57)	1.71(1.05~2.63)	-	0.96(0.59~1.45)	0.59(0.36~0.92)
南亚
1类	3.20(1.80~5.22)	3.34(1.81~5.48)	2.69(1.51~4.28)	6.48(3.72~10.30)	3.89(2.18~6.32)
2类	9.34(7.28~12.00)	4.84(3.63~6.42)	16.00(13.10~19.70)	7.06(5.37~9.07)	5.03(3.79~6.61)
3类	3.60(2.08~5.69)	5.80(3.63~8.45)	-	3.60(2.28~5.51)	1.79(1.09~2.86)
撒哈拉以南非洲
1类	2.04(1.37~2.97)	2.36(1.51~3.50)	2.32(1.53~3.40)	5.93(3.95~8.52)	2.74(1.81~3.97)
2类	11.70(9.55~14.30)	6.46(4.89~8.47)	20.30(16.60~24.80)	9.57(7.62~11.90)	5.36(4.29~6.66)
3类	2.07(1.19~3.27)	3.16(2.02~4.60)	-	2.03(1.30~3.12)	0.93(0.54~1.48)

表3

图1

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项目	下呼吸道感染和胸部所有相关感染	血液感染	腹膜和腹腔内感染
金黄色葡萄球菌
死亡人数（万人）	53.2 (44.0~64.8)	29.9 (16.6~48.5)	16.9 (10.5~25.3)
年龄标准化死亡率（/10万）	7.3 (6.0~8.8)	3.9 (2.1~6.3)	2.1 (1.3~3.2)
大肠埃希菌
死亡人数（万人）	18.1 (14.2~23.0)	24.2 (13.3~39.8)	29.0 (18.8~42.3)
年龄标准化死亡率（/10万）	2.6 (2.0~3.2)	3.2 (1.7~5.2)	3.7 (2.4~5.4)
肺炎链球菌
死亡人数（万人）	65.3 (55.3~77.7)	12.5 (7.3~19.9)	-
年龄标准化死亡率（/10万）	9.1(7.7~10.8)	1.6 (1.0~2.6)	-
肺炎克雷伯菌
死亡人数（万人）	27.6 (22.0~34.3)	26.5 (15.7~41.6)	15.8 (10.3~23.4)
年龄标准化死亡率（/10万）	3.8 (3.1~4.8)	3.5 (2.1~5.5)	2.0 (1.3~2.9)
铜绿假单胞菌
死亡人数（万人）	23.3 (18.1~30.2)	16.3 (9.5~25.5)	10.3 (6.6~15.1)
年龄标准化死亡率（/10万）	3.2 (2.5~4.1)	2.1 (1.2~3.3)	1.3 (0.8~1.9)
鲍曼不动杆菌
死亡人数（万人）	16.6 (9.2~26.7)	24.7 (13.8~40.5)	-
年龄标准化死亡率（/10万）	2.2 (1.2~3.5)	3.2 (1.8~5.2)	-
B组链球菌
死亡人数（万人）	18.2 (14.0~23.4)	7.6 (4.4~11.9)	-
年龄标准化死亡率（/10万）	2.6 (2.0~3.4)	1.0 (0.6~1.6)	-
脑膜炎奈瑟氏菌
死亡人数（万人）	-	11.0 (6.8~16.8)	-
年龄标准化死亡率（/10万）	-	1.5 (1.0~2.3)	-
粪肠球菌
死亡人数（万人）	-	7.5 (4.4~11.8)	11.3 (6.0~18.6)
年龄标准化死亡率（/10万）	-	1.0 (0.6~1.6)	1.4 (0.7~2.3)
屎肠球菌
死亡人数（万人）	-	7.8 (4.4~12.6)	11.8 (7.2~18.5)
年龄标准化死亡率（/10万）	-	1.0 (0.6~1.6)	1.5 (0.9~2.3)

病原体	下呼吸道感染和胸部所有相关感染	血液感染	腹膜和腹腔内感染
金黄色葡萄球菌	1 760 (1 440~2 160)	847 (509~1290)	491 (290~749)
大肠埃希菌	970 (720~1 280）	607 (363~927)	739 (459~1 110)
肺炎链球菌	3 250 (2 710~3 950)	496 (307~741)	-
肺炎克雷伯菌	1 350 (1 060~1 710)	1 070 (684~1 550)	386 (242~582)
铜绿假单胞菌	914 (714~1 160)	597 (377~891)	262 (159~397)