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Background <p>Lower respiratory tract infections (LRTIs) remain a leading cause of global infectious disease mortality, with <i>Staphylococcus aureus</i> emerging as a particular concern among older adults. The global spread of antimicrobial resistance, especially methicillin resistance (MRSA), represents a critical public health issue and limits treatment options in the elderly. In this study, we quantified global mortality trends of <i>S. aureus</i> LRTIs in older adults (≥ 70 years) from 1990 to 2021.</p> Methods <p>We analyzed MICROBE database data (1990–2021) for deaths and disability-adjusted life-years (DALYs) from <i>S. aureus</i> LRTIs in older adults (≥ 70 years) across 204 countries and territories. We extracted antimicrobial resistance-attributable deaths and DALYs, defined as excess mortality from resistant versus susceptible infections. Geographic aggregation followed the Global Burden of Disease framework at global, regional (21 regions), and super-regional (7 super-regions) levels. Statistical analyses were performed using SPSS and GraphPad Prism, with a significance threshold set at <i>p</i> &lt; 0.05.</p> Results <p><i>S. aureus</i> LRTI deaths in older adults increased threefold from 1990 to 2021. In 2021, LRTIs caused 3.54&#xa0;million deaths globally, with 1.94&#xa0;million deaths (54.8% of all-age deaths) among older adults. Sub-Saharan Africa showed the highest death and DALY rates, while high-income countries had the lowest. <i>S. aureus</i> caused 387,158 LRTI deaths worldwide (10.9% of all LRTIs mortality). Among older adults, <i>S. aureus</i> caused 250,347 deaths, with the largest absolute number in high-income settings but the highest mortality rate in sub-Saharan Africa (74.7 per 100 000). Deaths from <i>S. aureus</i>-associated LRTIs in older adults increased by 200% (a threefold increase) from 1990 to 2021. MRSA-associated age-standardized mortality in older adults remained 36.4% higher in 2021 compared to 1990, with mortality rates in older adults (15.18 per 100,000) being 6.7-fold higher than those aged 50–69 years.</p> Conclusion <p><i>S. aureus</i> LRTIs represent a substantial and increasing global burden, particularly in older adults. MRSA remains a persistent threat over three decades. The significant regional disparities and sustained upward trends underscore the urgent need for targeted interventions, improved antimicrobial stewardship programs, and strengthening infection prevention strategies, especially in high-risk regions and vulnerable elderly population.</p> Clinical trial <p>Not applicable.</p>

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Global burden of antimicrobial-resistant Staphylococcus aureus lower respiratory tract infections in older adults: a secondary analysis of the MICROBE database (1990–2021)

  • 期刊论文

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  • 发表日期：

    2026年5月21日

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  • Kunchen Wei,
  • Qingzhong Liu

摘要

Background

Lower respiratory tract infections (LRTIs) remain a leading cause of global infectious disease mortality, with Staphylococcus aureus emerging as a particular concern among older adults. The global spread of antimicrobial resistance, especially methicillin resistance (MRSA), represents a critical public health issue and limits treatment options in the elderly. In this study, we quantified global mortality trends of S. aureus LRTIs in older adults (≥ 70 years) from 1990 to 2021.

Methods

We analyzed MICROBE database data (1990–2021) for deaths and disability-adjusted life-years (DALYs) from S. aureus LRTIs in older adults (≥ 70 years) across 204 countries and territories. We extracted antimicrobial resistance-attributable deaths and DALYs, defined as excess mortality from resistant versus susceptible infections. Geographic aggregation followed the Global Burden of Disease framework at global, regional (21 regions), and super-regional (7 super-regions) levels. Statistical analyses were performed using SPSS and GraphPad Prism, with a significance threshold set at p < 0.05.

Results

S. aureus LRTI deaths in older adults increased threefold from 1990 to 2021. In 2021, LRTIs caused 3.54 million deaths globally, with 1.94 million deaths (54.8% of all-age deaths) among older adults. Sub-Saharan Africa showed the highest death and DALY rates, while high-income countries had the lowest. S. aureus caused 387,158 LRTI deaths worldwide (10.9% of all LRTIs mortality). Among older adults, S. aureus caused 250,347 deaths, with the largest absolute number in high-income settings but the highest mortality rate in sub-Saharan Africa (74.7 per 100 000). Deaths from S. aureus-associated LRTIs in older adults increased by 200% (a threefold increase) from 1990 to 2021. MRSA-associated age-standardized mortality in older adults remained 36.4% higher in 2021 compared to 1990, with mortality rates in older adults (15.18 per 100,000) being 6.7-fold higher than those aged 50–69 years.

Conclusion

S. aureus LRTIs represent a substantial and increasing global burden, particularly in older adults. MRSA remains a persistent threat over three decades. The significant regional disparities and sustained upward trends underscore the urgent need for targeted interventions, improved antimicrobial stewardship programs, and strengthening infection prevention strategies, especially in high-risk regions and vulnerable elderly population.

Clinical trial

Not applicable.