Improving the estimation of the global burden of antimicrobial resistant infections.

Estimating the global burden of disease from infections caused by pathogens that have acquired antimicrobial resistance (AMR) is essential for resource allocation and to inform AMR action plans at national and global levels. However, the scarcity of robust and accepted methods to determine burden is widely acknowledged. In this Personal View, we discuss the underlying assumptions, characteristics, limitations, and comparability of the approaches used to quantify mortality from AMR bacterial infections. We show that the global burdens of AMR estimated in previous studies are not comparable because of their different methodological approaches, assumptions, and data used to generate the estimates. The analytical frameworks from previous studies are inadequate, and we conclude that a new approach to the estimation of deaths caused by AMR infection is needed. The innovation of a new approach will require the development of mechanisms to systematically collect a clinical dataset of substantial breadth and quality to support the accurate assessment of burden, combined with decision-making and resource allocation for interventions against AMR. We define key actions required and call for innovative thinking and solutions to address these problems.

[1]  D. Ghosh,et al.  Diabetes reporting as a cause of death: results from the Translating Research Into Action for Diabetes (TRIAD) study. , 2006, Diabetes care.

[2]  Direk Limmathurotsakul,et al.  Epidemiology and burden of multidrug-resistant bacterial infection in a developing country , 2016, eLife.

[3]  Alan D. Lopez,et al.  Measuring and mapping the global burden of antimicrobial resistance , 2018, BMC Medicine.

[4]  A. Holmes,et al.  Investigating the impact of poverty on colonization and infection with drug-resistant organisms in humans: a systematic review , 2018, Infectious Diseases of Poverty.

[5]  R. Atun,et al.  Estimating the burden of antimicrobial resistance: a systematic literature review , 2018, Antimicrobial Resistance & Infection Control.

[6]  Stephan Harbarth,et al.  Will 10 Million People Die a Year due to Antimicrobial Resistance by 2050? , 2016, PLoS medicine.

[7]  P. Boelle,et al.  Accuracy of ICD-10 Codes for Surveillance of Clostridium difficile Infections, France , 2012, Emerging infectious diseases.

[8]  Mohammad Hossein Khosravi,et al.  Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017, Lancet.

[9]  J. Bellasio,et al.  Estimating the economic costs of antimicrobial resistance , 2014 .

[10]  D. Angus,et al.  Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. , 2016, American journal of respiratory and critical care medicine.

[11]  Hospital cause-of-death statistics: what should we make of them? , 2014, Bulletin of the World Health Organization.

[12]  Stefan Hagel,et al.  The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study , 2016, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[13]  K. Mertens,et al.  Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis , 2019, The Lancet. Infectious diseases.

[14]  Y. Carmeli,et al.  The negative impact of antibiotic resistance. , 2016, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[15]  C. Murray,et al.  On the comparable quantification of health risks: lessons from the Global Burden of Disease Study. , 1999, Epidemiology.

[16]  M. Lipsitch,et al.  Is methicillin-resistant Staphylococcus aureus replacing methicillin-susceptible S. aureus? , 2011, The Journal of antimicrobial chemotherapy.

[17]  R Westerling,et al.  Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics. , 2000, International journal of epidemiology.

[18]  K. Shamsuddin,et al.  Linking death reports from the Malaysian Family Life Survey-2 with birth and death certificates. , 1998, The Medical journal of Malaysia.

[19]  T. Burki.  Superbugs: An Arms Race Against Bacteria. , 2018, The Lancet. Respiratory medicine.

[20]  R. Bellomo,et al.  The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). , 2016, JAMA.

[21]  L. McGee,et al.  Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective , 2016, Clinical Microbiology Reviews.

[22]  R. Daum,et al.  Replacement of HA-MRSA by CA-MRSA Infections at an Academic Medical Center in the Midwestern United States, 2004-5 to 2008 , 2014, PloS one.

[23]  E. Lingaas,et al.  Secular trends in nosocomial bloodstream infections: antibiotic-resistant bacteria increase the total burden of infection. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  R. Weinstein.  Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics. , 2001, Emerging infectious diseases.

[25]  C. Dolecek,et al.  Microbiology Investigation Criteria for Reporting Objectively (MICRO): a framework for the reporting and interpretation of clinical microbiology data , 2019, BMC Medicine.

[26]  S. Dancer,et al.  Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination , 2014, Clinical Microbiology Reviews.

[27]  Tong Li,et al.  Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015 , 2017, The Lancet.

[28]  Louise A Knight,et al.  Quality assurance and good laboratory practice. , 2011, Methods in molecular biology.

[29]  Dan J Stein,et al.  Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2018, Lancet.

[30]  D. Raoult,et al.  Evaluating the Clinical Burden and Mortality Attributable to Antibiotic Resistance: The Disparity of Empirical Data and Simple Model Estimations , 2017, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.