Methods for estimating the burden of antimicrobial resistance: a systematic literature review protocol.
Estimates of the burden of antimicrobial resistance (AMR) are needed to ascertain AMR impact, to evaluate interventions, and to allocate resources efficiently. Recent studies have estimated health, cost, and economic burden relating to AMR, with outcomes of interest ranging from drug-bug resistance impact on mortality in a hospital setting to total economic impact of AMR on the global economy. However, recent collation of this information has been largely informal, with no formal quality assessment of the current evidence base (e.g. with predefined checklists). This review therefore aims to establish what perspectives and resulting methodologies have been used in establishing the burden of AMR, whilst also ascertaining the quality of these studies.



The literature review will identify relevant literature using a systematic review methodology. MEDLINE, EMBASE, Scopus and EconLit will be searched utilising a predefined search string. Grey literature will be identified by searching within a predefined list of organisational websites. Independent screening of retrievals will be performed in a two-stage process (abstracts and full texts), utilising a pre-defined inclusion and exclusion criteria. Data will be extracted into a data extraction table and descriptive examination will be performed. Study quality will be assessed using the Newcastle-Ottawa scales and the Philips checklists where appropriate. A narrative synthesis of the results will be presented.



This review will provide an overview of previous health, cost and economic definitions of burden and the resultant impact of these different definitions on the burden of AMR estimated. The review will also explore the methods that have been used to calculate this burden and discuss resulting study quality. This review can therefore act as a guide to methods for future research in this area.



PROSPERO CRD42016037510.
National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN, UK. n.naylor@imperial.ac.uk.
Nichola R
NR
Naylor
Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, London, UK.
Sachin
S
Silva
Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, London, UK.
Kavian
K
Kulasabanathan
National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN, UK.|Harvard University, 665 Huntington Avenue, Boston, MA, 02115, USA.
Rifat
R
Atun
National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN, UK.
Nina
N
Zhu
National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN, UK.
Gwenan M
GM
Knight
National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN, UK.|Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
Julie
J
Robotham
D000900:Anti-Bacterial Agents / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D003428:Cross Infection; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects / Q000235:genetics / Q000276:immunology; D006801:Humans; D008826:Microbial Sensitivity Tests; D017410:Practice Guidelines as Topic; D011634:Public Health; D015980:Public Health Practice; D012307:Risk Factors; D000078202:Systematic Reviews as Topic
D000900:Anti-Bacterial Agents
Antimicrobial resistance; Burden; Methods; Systematic review