Burden of Bacterial Antimicrobial Resistance in Libya, 1970-2024: A Systematic Meta-Analysis with Projections to 2050.
| Title: | Burden of Bacterial Antimicrobial Resistance in Libya, 1970-2024: A Systematic Meta-Analysis with Projections to 2050. |
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| Authors: | Bleiblo FA; Department of Microbiology, Faculty of Science, University of Benghazi, Benghazi P.O. Box 1308, Libya.; El-Awamie MW; Department of Microbiology, Faculty of Science, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Elsharif NA; Department of Microbiology, Faculty of Science, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Feetouri MM; Department of Biomedical Sciences, Faculty of Pharmacy, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Alogali IS; Department of Biomedical Sciences, Faculty of Pharmacy, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Mohamed AA; Department of Computer Science, School of Basic Sciences, Libyan Academy of Postgraduate Studies, Benghazi P.O. Box 1314, Libya.; Aloriby MA; Department of Pathology, Medical Center, Libyan International Medical University, Benghazi P.O. Box 84373, Libya.; El Salabi AA; Department of Public Health, Faculty of Medical Technology, University of Tripoli, Tripoli P.O. Box 82648, Libya.; Bader TS; NAVCO Pharmaceuticals, Burlington, ON L7L 6B5, Canada.; Moftah SA; Department of Physiology, Faculty of Medicine, University of Benghazi, Al-Marj Campus, Al-Marj P.O. Box 1308, Libya.; Alqabbasi OS; Department of Molecular Diagnostics, Faculty of Biomedical Sciences, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Abdeldaim GM; Department of Medical Microbiology, Faculty of Medicine, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Almajbry EM; Department of Microbiology, Faculty of Science, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Khamid MM; Department of Physiology, Faculty of Medicine, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Hasen YM; Department of Pathology, Faculty of Dentistry, University of Zawia, Zawia P.O. Box 16418, Libya.; Layas Y; Department of Chemistry, Faculty of Science, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Shamsi SS; Department of Medical Laboratory, Faculty of Medical Technology, Sebha University, Sebha P.O. Box 68, Libya.; Milad AM; Department of Pathology, Faculty of Dentistry, University of Zawia, Zawia P.O. Box 16418, Libya.; Alamami AD; Department of Biomedical Sciences, Faculty of Pharmacy, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Elraid GH; Department of Biomedical Sciences, Faculty of Pharmacy, University of Benghazi, Benghazi P.O. Box 1308, Libya.; Hamed AS; Laboratory of Microbiology, Al-Galaa Hospital, Benghazi P.O. Box 84373, Libya.; Altajouri AA; Asaleem Medical Laboratory, Unit of Microbiology, Benghazi P.O. Box 84373, Libya. |
| Source: | Antibiotics (Basel, Switzerland) [Antibiotics (Basel)] 2026 Jan 16; Vol. 15 (1). Date of Electronic Publication: 2026 Jan 16. |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101637404 Publication Model: Electronic Cited Medium: Print ISSN: 2079-6382 (Print) Linking ISSN: 20796382 NLM ISO Abbreviation: Antibiotics (Basel) Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: Basel, Switzerland : MDPI AG, 2012- |
| Abstract: | Background: Libya, a conflict-affected North African country, has a fragile health system and poor surveillance, leaving it largely underrepresented in global estimates. Earlier Libyan reviews were descriptive, lacking breakpoint standardization, isolate-level pooling, or AMR-attributable mortality and DALY estimates. To our knowledge, this study represents the first comprehensive report that integrates phenotypic and genotypic data to estimate deaths and DALYs attributable to AMR-induced mortality and morbidity, describe spatiotemporal patterns, and model future trajectories. Methods: We performed a meta-analysis according to the PRISMA 2020 guideline of Libyan studies reporting phenotypic or genotypic resistance among clinical bacterial isolates (1970-2024), combined with microbiology records from hospitals and national surveillance systems (preregistered in PROSPERO ID: CRD420251066018). Susceptibility results were standardized to CLSI/EUCAST and deduplicated using WHO GLASS first-isolate rules. We used random-effects meta-regression to estimate pooled resistance, and the counterfactual approach of Global Burden of Disease (GBD) was applied to estimate AMR-attributable DALYs. Molecular data on resistance genes, sequence types, and tuberculosis mutations were systematically collected. Results: We included 62 eligible studies together with national and facility-level surveillance datasets, providing isolate-level susceptibility data for 31,439 clinical isolates from Libya. In 2024, we estimated 2183 deaths (95% UI 1752-2614) attributable to AMR, representing 9.7% (95% UI 7.8-11.6) of total deaths with a mortality rate of 15.2 per 100,000 (12.2-18.2). DALYs attributable to AMR increased from 14,628 (95% UI 11,702-17,554) in 1970 to 96,715 (95% UI 77,372-116,058). The highest pooled resistance involved carbapenem-resistant/MDR A. baumannii, third-generation cephalosporin- and fluoroquinolone-resistant Enterobacterales, and carbapenem-resistant P. aeruginosa. Molecular data showed widespread ESBLs, OXA-/NDM-type carbapenemases, plasmid-mediated colistin resistance, high-risk E. coli ST131 and K. pneumoniae ST147 lineages, and canonical drug-resistant M. tuberculosis mutations. Conclusions: Combined with global and regional evidence, our findings suggest a high and increasing burden of AMR in Libya. These findings emphasize the need for rapid expansion of data collection systems, GLASS-aligned surveillance, diagnostic capacities, and infection control measures. |
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| Contributed Indexing: | Keywords: Gram-negative bacterial infections; Libya; PRISMA; antimicrobial resistance; disability-adjusted life years; global burden of disease; meta-analysis; multidrug-resistant pathogens; tuberculosis |
| Entry Date(s): | Date Created: 20260128 Date Completed: 20260128 Latest Revision: 20260131 |
| Update Code: | 20260131 |
| PubMed Central ID: | PMC12837905 |
| DOI: | 10.3390/antibiotics15010092 |
| PMID: | 41594129 |
| Database: | MEDLINE |
Journal Article; Review