Tomislav Meštrović, Department of Nursing, University Centre Varaždin, University North, Ul. 104. brigade 3, 42 000 Varaždin, Croatia,
Croat Med J. 2023 Aug 31;64(4):272-283. doi: 10.3325/cmj.2023.64.272.
To deliver the most wide-ranging set of antimicrobial resistance (AMR) burden estimates for Croatia to date.
A complex modeling approach with five broad modeling components was used to estimate the disease burden for 12 main infectious syndromes and one residual group, 23 pathogenic bacteria, and 88 bug-drug combinations. This was represented by two relevant counterfactual scenarios: deaths/disability-adjusted life years (DALYs) that are attributable to AMR considering a situation where drug-resistant infections are substituted with sensitive ones, and deaths/DALYs associated with AMR considering a scenario where people with drug-resistant infections would instead present without any infection. The 95% uncertainty intervals (UI) were based on 1000 posterior draws in each modeling step, reported at the 2.5% and 97.5% of the draws' distribution, while out-of-sample predictive validation was pursued for all the models.
The total burden associated with AMR in Croatia was 2546 (95% UI 1558-3803) deaths and 46958 (28,033-71,628) DALYs, while the attributable burden was 614 (365-943) deaths and 11321 (6,544-17,809) DALYs. The highest number of deaths was established for bloodstream infections, followed by peritoneal and intra-abdominal infections and infections of the urinary tract. Five leading pathogenic bacterial agents were responsible for 1808 deaths associated with resistance: Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa (ordered by the number of deaths). Trimethoprim/sulfamethoxazole-resistant E coli and methicillin-resistant S. aureus were dominant pathogen-drug combinations in regard to mortality associated with and attributable to AMR, respectively.
We showed that AMR represented a substantial public health concern in Croatia, which reflects global trends; hence, our detailed country-level findings may fast-track the implementation of multipronged strategies tailored in accordance with leading pathogens and pathogen-drug combinations.
提供迄今为止克罗地亚关于抗菌药物耐药性（AMR）负担的最全面估计。
采用包含五个广泛建模组成部分的复杂建模方法，估计 12 种主要传染病综合征和一个剩余组、23 种病原体和 88 种细菌-药物组合的疾病负担。这通过两个相关的反事实情景来表示：考虑到耐药感染被敏感感染替代的情况下，归因于 AMR 的死亡/残疾调整生命年（DALY），以及考虑到具有耐药感染的人反而没有任何感染的情况下，与 AMR 相关的死亡/DALY。95%的不确定性区间（UI）基于每个建模步骤中的 1000 个后验抽取，在抽取分布的第 2.5%和第 97.5%处报告，同时对所有模型进行了样本外预测验证。
克罗地亚与 AMR 相关的总负担为 2546 例死亡（95%UI 1558-3803）和 46958 个 DALY（28033-71628），而归因于 AMR 的负担为 614 例死亡（365-943）和 11321 个 DALY（6544-17809）。导致死亡人数最多的是血流感染，其次是腹膜和腹腔内感染以及尿路感染。五种主要病原体负责与耐药相关的 1808 例死亡：大肠杆菌、金黄色葡萄球菌、鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌（按死亡人数排序）。甲氧苄啶/磺胺甲恶唑耐药大肠杆菌和耐甲氧西林金黄色葡萄球菌分别是与 AMR 相关和归因于 AMR 的死亡率方面的主要病原体-药物组合。
我们表明，AMR 在克罗地亚是一个重大的公共卫生问题，反映了全球趋势；因此，我们详细的国家级发现可能会加快实施根据主要病原体和病原体-药物组合量身定制的多管齐下的策略。
