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. 2017 Mar 7;6(1):9.
doi: 10.3390/antibiotics6010009.

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

Daniel Carter  1 , André Charlett  2 , Stefano Conti  3 , Julie V Robotham  4 , Alan P Johnson  5 , David M Livermore  6 , Tom Fowler  7 , Mike Sharland  8 , Susan Hopkins  9 , Neil Woodford  10 , Philip Burgess  11 , Stephen Dobra  12
Affiliations

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

Daniel Carter et al. Antibiotics (Basel). .

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.

Keywords: Bayesian modelling; antibiotic resistance; risk assessment.

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Conflict of interest statement

Julie V. Robotham, Alan P. Johnson and David M. Livermore are members of the UK government Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI). Mike Sharland is the Chair of ARHAI. David M. Livermore is a member of Advisory Boards or has undertaken ad-hoc consultancy for Accelerate, Achaogen, Adenium, Allecra, AstraZeneca, Auspherix, Basilea, BioVersys, Cubist, Centauri, Discuva, Meiji, Pfizer, Roche, Shionogi, Tetraphase, VenatoRx, Wockhardt, Zambon, Zealand, Paid lectures—AstraZeneca, Cepheid, Merck and Nordic. Relevant shareholdings in—Dechra, GSK, Merck, Perkin Elmer, Pfizer amounting to <10% of portfolio value. Contract research/grants from Allecra, AstraZeneca, Melinta, Merck, Roche, Wockhardt. All other authors have none to declare.

Figures

Figure 1
Figure 1
Prior distributions of the expert panel elicitation.
Figure 2
Figure 2
Posterior distribution of the probability of the scenario occurring within five years.
See this image and copyright information in PMC

References

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