Estimating the burden of antimicrobial resistance: a systematic literature review

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Title: Estimating the burden of antimicrobial resistance: a systematic literature review
Author(s): Naylor, NR
Atun, R
Zhu, N
Kulasabanathan, K
Silva, S
Chatterjee, A
Knight, G
Robotham, J
Item Type: Journal Article
Abstract: Background: Accurate estimates of the burden of antimicrobial resistance (AMR) are needed to establish the magnitude of this global threat in terms of both health and cost, and to enable cost-effectiveness evaluations of interventions aiming to tackle the problem. This review aimed to establish the alternative methodologies used in estimating AMR burden in order to appraise the current evidence base. Methods: MEDLINE, EMBASE, Scopus, EconLit, PubMed and grey literature were searched. English language studies evaluating the impact of AMR (from any microbe) on patient, payer/provider and economic burden published between January 2013 and December 2015 were included. Independent screening of title/abstracts followed by full texts was performed using pre-specified criteria. A study quality score (from zero to one) was derived using Newcastle-Ottawa and Phillips checklists. Extracted study data were used to compare study method and resulting burden estimate, according to perspective. Monetary costs were converted into 2013 USD. Results: Out of 5,187 unique retrievals, 214 studies were included. 187 studies estimated patient health, 75 studies estimated payer/provider and 11 studies estimated economic burden. 64% of included studies were single centre. The majority of studies estimating patient or provider/payer burden used regression techniques. 48% of studies estimating mortality burden found a significant impact from resistance, excess healthcare system costs ranged from non-significance to $1 billion per year, whilst economic burden ranged from $21,832 per case to over $3 trillion in GDP loss. Median quality scores (interquartile range) for patient, payer/provider and economic burden studies were 0.67 (0.56-0.67), 0.56 (0.46-0.67) and 0.53 (0.44-0.60) respectively. Conclusions: This study highlights what methodological assumptions and biases can occur dependent on chosen outcome and perspective. Currently, there is considerable variability in burden estimates, which can lead in-turn to inaccurate intervention evaluations and poor policy/investment decisions. Future research should utilise the recommendations presented in this review.
Publication Date: 25-Apr-2018
Date of Acceptance: 1-Mar-2018
URI: http://hdl.handle.net/10044/1/57796
DOI: https://dx.doi.org/10.1186/s13756-018-0336-y
ISSN: 2047-2994
Publisher: BioMed Central
Journal / Book Title: Antimicrobial Resistance and Infection Control
Volume: 7
Copyright Statement: © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.
Keywords: Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Infectious Diseases
Microbiology
Antimicrobial resistance
Antibiotic resistance
Burden
Cost
BLOOD-STREAM-INFECTION
STAPHYLOCOCCUS-AUREUS BACTEREMIA
LENGTH-OF-STAY
VENTILATOR-ASSOCIATED PNEUMONIA
INTENSIVE-CARE-UNIT
SPONTANEOUS BACTERIAL PERITONITIS
KIDNEY-TRANSPLANT RECIPIENTS
HOSPITAL-ACQUIRED INFECTION
BETA-LACTAMASE PRODUCTION
URINARY-TRACT-INFECTION
Antibiotic resistance
Antimicrobial resistance
Burden
Cost
Publication Status: Published
Article Number: 58
Appears in Collections:Department of Medicine
Faculty of Medicine



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