The most comprehensive estimates of antimicrobial resistance (AMR) burden to date are presented in this study.

• Deaths and disability-adjusted life-years (DALYs) attributable to and linked with bacterial AMR are determined for 23 pathogens and 88 pathogen–drug combinations in 204 countries and territories in 2019.

• A total of 471 million individual records or isolates and 7,585 study-location-years were included via assessing data retrieved from systematic literature reviews, hospital systems, surveillance systems, and other sources.

• Predictive statistical modeling was utilized to generate estimates of AMR burden for all locations, including for locations with no data.

• A total of 4·95 million (3·62–6·57) deaths are estimated to be linked with bacterial AMR in 2019, including 1·27 million deaths attributable to bacterial AMR.

• At the regional level, western sub-Saharan Africa was estimated to have the highest all-age death rate attributable to resistance, and Australasia had the lowest.

• Lower respiratory infections were noted to be the most burdensome infectious syndrome given their correlation with more than 1·5 million deaths associated with resistance in 2019.

• Following were the six leading pathogens for deaths associated with resistance that were responsible for 929,000 deaths attributable to AMR and 3·57 million deaths associated with AMR in 2019: Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa.

• This is the first comprehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data.

• With the highest burdens in low-resource settings, researchers identified AMR to be a leading cause of death around the world.

• By attaining an insight into the burden of AMR and the leading pathogen–drug combinations contributing to it, it will be possible to make informed and location-specific policy decisions, particularly concerning infection prevention and control programs, access to essential antibiotics, and research and development of new vaccines and antibiotics.

• Because of serious data gaps in many low-income settings, researchers emphasize the necessity to expand microbiology laboratory capacity and data collection systems to enhance the knowledge concerning this important human health threat.