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Estimating the number of infections caused by antibiotic-resistant Escherichia coli and Klebsiella pneumoniae in 2014: a modelling study

Temkin E, Fallach N, Almagor J, Gladstone BP, Tacconelli E, Carmeli Y; DRIVE-AB Consortium.

Lancet Glob Health. 2018 Sep;6(9):e969-e979. doi: 10.1016/S2214-109X(18)30278-X.

Background: The number of infections caused by resistant organisms is largely  unknown. We estimated the number of infections worldwide that are caused  by the WHO priority pathogens third-generation cephalosporin-resistant  and carbapenem-resistant Escherichia coli and Klebsiella pneumoniae.

Methods: We calculated a uniform weighted mean incidence of serious  infections caused by antibiotic-susceptible E coli and K pneumoniae  using data from 17 countries. Using this uniform incidence, as well as  population sizes and country-specific resistance levels, we estimated  the number of infections caused by third-generation  cephalosporin-resistant and carbapenem-resistant E coli and K pneumoniae  in 193 countries in 2014. We also calculated interval estimates derived  from changing the fixed incidence of susceptible infections to 1 SD  below and above the weighted mean. We compared an additive model with  combination models in which resistant infections were replaced by  susceptible infections. We distinguished between higher-certainty  regions (those with good-quality data sources for resistance levels and  resistance ≤30%), moderate-certainty regions (those with good-quality  data sources for resistance levels and including some countries with  resistance >30%), and low-certainty regions (those in which  good-quality data sources for resistance levels were unavailable for  countries comprising at least 20% of the region's population, regardless  of resistance level).

Findings: Using the additive model, we estimated that third-generation  cephalosporin-resistant E coli and K pneumoniae caused 6·4 million  (interval estimate 3·5-9·2) bloodstream infections and 50·1 million  (27·5-72·8) serious infections in 2014; estimates were 5·5 million  (3·0-7·9) bloodstream infections and 43·1 million (23·6-62·2) serious  infections in the 25% replacement model, 4·6 million (2·5-6·6)  bloodstream infections and 36·0 million (19·7-52·2) serious infections  in the 50% replacement model, and 3·7 million (2·0-5·3) bloodstream  infections and 28·9 million (15·8-41·9) serious infections in the 75%  replacement model. Carbapenem-resistant strains caused 0·5 million  (0·3-0·7) bloodstream infections and 3·1 million (1·8-4·5) serious  infections based on the additive model, 0·5 million (0·3-0·7)  bloodstream infections and 3·0 million (1·7-4·3) serious infections  based on the 25% replacement model, 0·4 million (0·2-0·6) bloodstream  infections and 2·8 million (1·6-4·1) serious infections based on the 50%  replacement model, and 0·4 million (0·2-0·6) bloodstream infections and  2·7 million (1·5-3·8) serious infections based on the 75% replacement  model.

Interpretation: To our knowledge, this study is the first to report estimates of  the global number of infections caused by antibiotic-resistant priority  pathogens. Uncertainty stems from scant data on resistance levels from  low-income and middle-income countries and insufficient knowledge  regarding resistance dynamics when resistance is high.

Funding:  Innovative Medicines Initiative.

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