Burden of antimicrobial resistance and estimated economic impact of Klebsiella pneumoniae in Iran- A 2000 to 2021 analysis.

Background: Antimicrobial resistance (AMR) in Klebsiella pneumoniae (K. pneumoniae) poses a growing public health threat in Iran. This study assessed the burden of K. pneumoniae AMR from 2000 to 2021, including deaths, disability-adjusted life years (DALYs), and economic impact. Methods: Using 2021 AMR project data, we estimated deaths and DALYs per 100,000 population with 95 % uncertainty intervals under two scenarios: attributable (resistant replaced by susceptible infections) and associated (resistant replaced by no infection). Economic burden was calculated using GDP per capita and PPP-adjusted estimates. Results: The deaths from K. pneumoniae AMR increased from 565.9 to 643.5, while the age-standardized rate of deaths decreased from 1.5 to 0.9 per 100,000 people. DALYs dropped from 29523.4 to 18787.1, with the ASR decreasing from 60.2 to 25.3 per 100,000 people. Carbapenem resistance rose from 7.5 % to 20 %, increasing all-age attributable deaths from 76.1 to 175.0. Deaths and death rates fell for under-20s. For those 30 and over, death counts rose while the rate itself fell, stabilizing only for ages 85+. Despite a slight decrease, the economic burden was estimated at between 291.1 and 873.31 million USD PPP in 2021. Conclusions: While the overall burden of K. pneumoniae AMR has declined, it remains high in older adults. Strengthening water, sanitation, and hygiene (WASH) programs, antibiotic stewardship (ASP), and prescribing practices are essential.