A Risk Assessment of Antibiotic Pan-Drug-Resistance in the UK: Bayesian Analysis of an Expert Elicitation Study

Abstract

To inform the UK antimicrobial resistance strategy, a risk assessment was undertaken of the likelihood, over a five-year time-frame, of the emergence and widespread dissemination of pan-drug-resistant (PDR) Gram-negative bacteria that would pose a major public health threat by compromising effective healthcare delivery. Subsequent impact over five- and 20-year time-frames was assessed in terms of morbidity and mortality attributable to PDR Gram-negative bacteraemia. A Bayesian approach, combining available data with expert prior opinion, was used to determine the probability of the emergence, persistence and spread of PDR bacteria. Overall probability was modelled using Monte Carlo simulation. Estimates of impact were also obtained using Bayesian methods. The estimated probability of widespread occurrence of PDR pathogens within five years was 0.2 (95% credibility interval (CrI): 0.07–0.37). Estimated annual numbers of PDR Gram-negative bacteraemias at five and 20 years were 6800 (95% CrI: 400–58,600) and 22,800 (95% CrI: 1500–160,000), respectively; corresponding estimates of excess deaths were 1900 (95% CrI: 0–23,000) and 6400 (95% CrI: 0–64,000). Over 20 years, cumulative estimates indicate 284,000 (95% CrI: 17,000–1,990,000) cases of PDR Gram-negative bacteraemia, leading to an estimated 79,000 (95% CrI: 0–821,000) deaths. This risk assessment reinforces the need for urgent national and international action to tackle antibiotic resistance.

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“…Surprisingly, the incidence of infections by resistant bacteria was higher in countries with high use (ie, Portugal) compared with those with lower use (ie, Iceland or Norway) of antibiotics. Similarly, Carter et al 45 calculated the cost of infections produced by pandrug-resistant Gram-negative bacteria in the UK in an estimated 79 000 deaths over a 20-year period. With regard to the role of antibiotics on preventing complications, Babar-Craig et al 46 reported that complications requiring surgical intervention were similar in patients receiving antibiotic treatment or not.…”

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“…Kentucky strains might pose in the near future. A recent risk assessment study on Antibiotic Pan Drug Resistance (PDR) in the UK has estimated 284,000 cases of PDR Gram-negative bacteraemia leading to 79,000 deaths in a span of 20 years [ 103 ].…”

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“… 15 Moreover, due to the abuse of broad-spectrum antibiotics in clinics and transfection of antibiotic resistance genes, the prevalence of PDR appears to be increasing. 29 , 30 PDR infections pose a great challenge to the current antibiotic management. Therefore, it is urgent to explore new antibiotics for PDR infections.…”