Basic sociodemographic information about respondents (unweighted n = 1197 and weighted n = 1198 data).

Basic sociodemographic information about respondents (unweighted n = 1197 and weighted n = 1198 data).</p

S1 Data -

To determine the prevalence of genital Chlamydia trachomatis (chlamydia) infection, knowledge about chlamydia and experience of previous testing for chlamydia, we carried out a national probability-based survey in emerging adults aged 18–25 years in Croatia in 2021–2022. Participants (n = 1197), members of a national online panel, completed a web-based questionnaire that collected information on socio-demographics, sexual behaviours and knowledge about sexually transmitted infections (STIs). Urine specimens from a sample of sexually experienced participants were self-collected and tested for chlamydia using Cobas 4800 CT/NG test. To achieve broad representativeness of the emerging adult population in the country, we applied post-hoc weighting for gender and age. Multivariable ordinary least squares linear regression was used to determine correlates of knowledge about chlamydia infection and binomial logistic regression to assess correlates of the willingness to test for chlamydia. Among 448 participants who sent in their urine specimens chlamydia prevalence was 2.5% (95% CI 1.2–5.1) in women and 1.0% (0.3–3.2%) in men. A total of 8.0% of women and 4.7% men reported testing for chlamydia prior to the survey. About a quarter of the sample was characterized by not answering correctly any of the six questions related to knowledge about chlamydia, while only 9.6% had five or six correct answers. In the multivariable analysis, significantly higher odds of willingness to test for chlamydia were found in females compared to males (OR = 1.34, p = 0.024), those with better knowledge about the infection (OR = 1.11, p = 0.005), and those with lower religiosity (OR = 0.91, p = 0.017). In conclusion, prevalence of chlamydia in emerging adults in Croatia is considerable. Efforts to control this infection should focus on primary prevention and targeted testing combined with effective case management strategies.</div

Predictors and correlates of chlamydia testing (<i>n</i> = 921).

Predictors and correlates of chlamydia testing (n = 921).</p

Predictors and correlates of knowledge about chlamydia (<i>n</i> = 921).

Predictors and correlates of knowledge about chlamydia (n = 921).</p

Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods: We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. Findings: From an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2–18·1) of all global deaths and 56·2% (52·1–60·1) of all sepsis-related deaths in 2019. Five leading pathogens—Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa—were responsible for 54·9% (52·9–56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185–285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4–71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation: The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. Funding: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund

Age-standardized YLL, YLD, and DALY rates (95% UI) and country ranks (from best to worst) for Poland and other Central European countries, for both sexes combined, males, and females, in 1990 and 2017.

Age-standardized YLL, YLD, and DALY rates (95% UI) and country ranks (from best to worst) for Poland and other Central European countries, for both sexes combined, males, and females, in 1990 and 2017.</p

Changes in disease burden in Poland between 1990–2017 in comparison with other Central European countries: A systematic analysis for the Global Burden of Disease Study 2017 - Fig 1

Age-standardized rates in 2017 (left) and relative (%) change from 1990 to 2017 (right) for YLLs, YLDs, and DALYs for males, females, and both sexes combined for Poland, Eastern Europe, Central Europe, and Western Europe.</p

Observed-to-expected ratios for age-standardized YLL, YLD, and DALY rates for both sexes from all causes in Central European countries in 2017.

Observed-to-expected ratios for age-standardized YLL, YLD, and DALY rates for both sexes from all causes in Central European countries in 2017.</p

Ranking of Central European countries according to all-cause DALY rates for both sexes combined in 1990 and 2017, by age categories.

Ranking of Central European countries according to all-cause DALY rates for both sexes combined in 1990 and 2017, by age categories.</p

Changes in disease burden in Poland between 1990–2017 in comparison with other Central European countries: A systematic analysis for the Global Burden of Disease Study 2017 - Fig 3

Leading Level 4 causes of YLLs (a), YLDs (b), and DALYs (c) in Central European countries, with the ratio of observed to expected (OER) age-standardized rates by location: (a) YLLs, (b) YLDs, (c) DALYs. Colors represent OER ranges: 0–0.54 = blue, 0.55–0.69 = green, 0.70–0.84 = light green, 0.85–0.99 = yellow green, 1.0 = white, 1.01–1.24 = dark yellow, 1.25–1.66 = orange, 1.67–2.91 = dark orange, 2.92+ = red.</p