Wozniak Teresa M, Dyda Amalie, Merlo Greg, Hall Lisa
Australian e-Health Research Centre CSIRO, Brisbane, Queensland, Australia.
Menzies School of Health Research, Darwin, Northern Territory, Australia.
Lancet Reg Health West Pac. 2022 Jul 7;27:100521. doi: 10.1016/j.lanwpc.2022.100521. eCollection 2022 Oct.
The growing spread of antimicrobial resistance (AMR) is accepted as a threat to humans, animals and the environment. This threat is considered to be both country specific and global, with bacteria resistant to antibiotic treatment geographically dispersed. Despite this, we have very few Australian estimates available that use national surveillance data supplemented with measures of risk, to generate reliable and actionable measures of AMR impact. These data are essential to direct policies and programs and support equitable healthcare resource utilisation. Importantly, such data can lead to implementation of programs to improved morbidity and mortality of patients with a resistant infection.
Using data from a previous case-cohort study, we estimated the AMR-associated health and economic impact caused by five hospital-associated AMR pathogens (, and ) in patients with a bloodstream, urinary tract, or respiratory tract infection in Australia in 2020. We estimated disease burden based on the counterfactual scenario in which all AMR infections were replaced by no infection.We used a population-level simulation model to compute AMR-associated mortality, loss of quality-adjusted life years and costs.
In 2020, there were 1,031 AMR-associated deaths (95% uncertainty interval [UI] 294, 2,615) from the five resistant hospital-associated infections in Australia. The greatest odds of dying were from respiratory infections (ceftazidime-resistant ) and bloodstream infections, both resulting in high hospital and premature death costs. MRSA bacteraemia contributed the most to hospital costs (measured as bed-days) as patients with this infection resulted in additional 12,818 (95% UI 7246, 19966) hospital bed-days and cost the hospitals an extra $24,366,741 (95%UI $13,774,548, $37,954,686) per year. However, the cost of premature death from five resistant pathogens was $438,543,052, which was by far greater than the total hospital cost ($71,988,858). We estimate a loss of 27,705 quality-adjusted life years due to the five AMR pathogens.
These are the first Australian estimates of AMR-associated health and economic impact. Country-level estimates of AMR impact are needed to provide local evidence to better inform programs and health policies to reduce morbidity and mortality associated with infection. The burden in hospital is likely an underestimate of the impact of AMR due to community-associated infections where data are limited, and the AMR burden is high. This should now be the focus of future study in this area.
TMW was supported by the Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE) (grant number GNT1116530) Fellowship.
抗菌药物耐药性（AMR）的日益扩散被认为是对人类、动物和环境的一种威胁。这种威胁被认为既有国家层面的，也有全球层面的，对抗生素治疗耐药的细菌在地理上广泛分布。尽管如此，我们几乎没有利用澳大利亚国家监测数据并辅以风险衡量指标得出的、能产生可靠且可采取行动的AMR影响衡量指标。这些数据对于指导政策和项目以及支持公平的医疗资源利用至关重要。重要的是，此类数据可促使实施相关项目以改善耐药感染患者的发病率和死亡率。
利用先前一项病例队列研究的数据，我们估计了2020年澳大利亚血流感染、尿路感染或呼吸道感染患者中五种医院相关AMR病原体（、和）所造成的与AMR相关的健康和经济影响。我们基于所有AMR感染都被无感染取代的反事实情景来估计疾病负担。我们使用了一个人群水平的模拟模型来计算与AMR相关的死亡率、质量调整生命年损失和成本。
2020年，澳大利亚因五种医院相关耐药感染导致1031例与AMR相关的死亡（95%不确定区间[UI]为294，2615）。死亡几率最高的是呼吸道感染（对头孢他啶耐药的）和血流感染，这两种感染都导致了高昂的住院费用和过早死亡成本。耐甲氧西林金黄色葡萄球菌菌血症对医院成本（以住院天数衡量）的贡献最大，因为感染这种病菌的患者每年额外增加12818（95%UI为7246，19966）个住院日，使医院每年额外花费24366741美元（95%UI为13774548美元，37954686美元）。然而，五种耐药病原体导致的过早死亡成本为438543052美元，远远高于总住院成本（71988858美元）。我们估计这五种AMR病原体导致了27705个质量调整生命年的损失。
这些是澳大利亚首次对与AMR相关的健康和经济影响进行的估计。需要进行国家层面的AMR影响估计，以提供本地证据，更好地为降低与感染相关的发病率和死亡率的项目及卫生政策提供信息。由于社区相关感染的数据有限且AMR负担较高，医院的负担可能低估了AMR的影响。这现在应该成为该领域未来研究的重点。
TMW得到了澳大利亚传染病紧急情况防范研究伙伴关系（APPRISE）（资助编号GNT1116530）奖学金的支持。
