{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T12:28:53Z","timestamp":1787833733401,"version":"build-2784847793"},"reference-count":92,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>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\u20132024), 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\u20132614) attributable to AMR, representing 9.7% (95% UI 7.8\u201311.6) of total deaths with a mortality rate of 15.2 per 100,000 (12.2\u201318.2). DALYs attributable to AMR increased from 14,628 (95% UI 11,702\u201317,554) in 1970 to 96,715 (95% UI 77,372\u2013116,058). 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.<\/jats:p>","DOI":"10.3390\/antibiotics15010092","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T09:28:12Z","timestamp":1768555692000},"page":"92","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Burden of Bacterial Antimicrobial Resistance in Libya, 1970\u20132024: A Systematic Meta-Analysis with Projections to 2050"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6676-3962","authenticated-orcid":false,"given":"Farag A.","family":"Bleiblo","sequence":"first","affiliation":[{"name":"Department of Microbiology, Faculty of Science, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madiha W.","family":"El-Awamie","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Science, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nariman A.","family":"Elsharif","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Science, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muetaz M.","family":"Feetouri","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Faculty of Pharmacy, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibtihag S.","family":"Alogali","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Faculty of Pharmacy, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelhafid A.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Computer Science, School of Basic Sciences, Libyan Academy of Postgraduate Studies, Benghazi P.O. Box 1314, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud A.","family":"Aloriby","sequence":"additional","affiliation":[{"name":"Department of Pathology, Medical Center, Libyan International Medical University, Benghazi P.O. Box 84373, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allaaeddin A.","family":"El Salabi","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medical Technology, University of Tripoli, Tripoli P.O. Box 82648, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek S.","family":"Bader","sequence":"additional","affiliation":[{"name":"NAVCO Pharmaceuticals, Burlington, ON L7L 6B5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Souad A.","family":"Moftah","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, University of Benghazi, Al-Marj Campus, Al-Marj P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar S.","family":"Alqabbasi","sequence":"additional","affiliation":[{"name":"Department of Molecular Diagnostics, Faculty of Biomedical Sciences, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guma M.","family":"Abdeldaim","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Faculty of Medicine, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman M.","family":"Almajbry","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Science, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed M.","family":"Khamid","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousef M.","family":"Hasen","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Dentistry, University of Zawia, Zawia P.O. Box 16418, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusra","family":"Layas","sequence":"additional","affiliation":[{"name":"Department of Chemistry, Faculty of Science, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9941-5019","authenticated-orcid":false,"given":"Shamsi S.","family":"Shamsi","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory, Faculty of Medical Technology, Sebha University, Sebha P.O. Box 68, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali M.","family":"Milad","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Dentistry, University of Zawia, Zawia P.O. Box 16418, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1536-9343","authenticated-orcid":false,"given":"Abdulah D.","family":"Alamami","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Faculty of Pharmacy, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7729-6896","authenticated-orcid":false,"given":"Ghaliah H.","family":"Elraid","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Faculty of Pharmacy, University of Benghazi, Benghazi P.O. Box 1308, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziza S.","family":"Hamed","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Al-Galaa Hospital, Benghazi P.O. Box 84373, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aeshah A.","family":"Altajouri","sequence":"additional","affiliation":[{"name":"Asaleem Medical Laboratory, Unit of Microbiology, Benghazi P.O. Box 84373, Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025, January 06). Antimicrobial Resistance Fact Sheet. Available online: https:\/\/www.who.int\/docs\/default-source\/antimicrobial-resistance\/amr-factsheet.pdf."},{"key":"ref_2","unstructured":"Institute for Health Metrics and Evaluation (2025, January 06). Global Burden of Disease Study 2023. Available online: https:\/\/ghdx.healthdata.org\/gbd-2023."},{"key":"ref_3","unstructured":"O\u2019Neill, J. (2025, April 12). Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. Review on Antimicrobial Resistance. 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