Disease burden, associated mortality and economic impact of antimicrobial resistant infections in Australia.

Background: 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. Methods: Using data from a previous case-cohort study, we estimated the AMR-associated health and economic impact caused by five hospital-associated AMR pathogens (Enterococcus spp., E. coli, K. pneumoniae, P. aeruginosa and S. aureus) 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. Findings: 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 P. aeruginosa) 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. Interpretation: 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. Funding: TMW was supported by the Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE) (grant number GNT1116530) Fellowship.