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Synthesizing pathogen- and infection-specific estimates of the burden of antimicrobial resistance in Europe for health-technology assessment: gaps, heterogeneity, and bias

Robotham JV, Tacconelli E, Vella V and de Kraker MEA.

Antimicrobial resistance (AMR) causes a high burden of disease. The European Centre for Disease Prevention and Control has estimated that in 2019, AMR caused 865 767 infections, 38 710 attributable deaths, and 1 101 288 disability-adjusted life years, in Europe [[1]]. Because increasing rates of AMR further reduce the effectiveness of last resort antibiotics, novel treatment strategies are urgently needed. According to Butler and Paterson [[2]], between 2017 and 2021, 12 new antibiotics were approved, of which only vaborbactam belonged to a new class. Among 16 antimicrobial agents in phase III or under regulatory evaluation, only 4 have new modes of action. Vaccines and monoclonal antibodies (mAbs) could offer a promising alternative for prevention or treatment of infections [[3]]. The added advantage of vaccines is that they can reduce the need for antibiotic prescribing, through a reduction of the disease itself (bacterial vaccines) or a reduced number of bacterial superinfections (viral vaccines). Because antibiotic use is a key driver of AMR, a lower need for antibiotic prescribing can have knock-on benefits, slowing development, and spread of resistance in the population. In addition, evolution of vaccine resistance is less likely than AMR development, because vaccines have a multiplicity of targets and are mostly used prophylactically against invasive infection [[4]]. Serotype replacement, such as after the implementation of Streptococcus pneumoniae vaccination, might reduce vaccine sustainability [[5]]. However, this is a much slower process, and vaccine serotype coverage can be updated over time. For mAbs, antigenic escape could occur, but this can be overcome by using mAbs cocktails or bi-specific mAbs. Moreover, mAbs tend to have a long half-life, extending their clinical efficacy [[6]].

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