title: A Risk Assessment of Antibiotic Pan-Drug-Resistance in the UK: Bayesian Analysis of an Expert Elicitation Study.
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.
authors.affiliation: National Infection Service, Public Health England, London NW9 5EQ, UK. d-carter@dfid.gov.uk.
authors.forename: Daniel
authors.initials: D
authors.lastname: Carter
authors.affiliation: National Infection Service, Public Health England, London NW9 5EQ, UK. andre.charlett@phe.gov.uk.
authors.forename: André
authors.initials: A
authors.lastname: Charlett
authors.affiliation: National Infection Service, Public Health England, London NW9 5EQ, UK. stefano.conti@nhs.net.
authors.forename: Stefano
authors.initials: S
authors.lastname: Conti
authors.affiliation: National Infection Service, Public Health England, London NW9 5EQ, UK. julie.robotham@phe.gov.uk.
authors.forename: Julie V
authors.initials: JV
authors.lastname: Robotham
authors.affiliation: National Infection Service, Public Health England, London NW9 5EQ, UK. alan.johnson@phe.gov.uk.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK. d.livermore@uea.ac.uk.
authors.forename: David M
authors.initials: DM
authors.lastname: Livermore
authors.affiliation: National Infection Service, Public Health England, London NW9 5EQ, UK. tom.fowler@phe.gov.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Fowler
authors.affiliation: Paediatric Infectious Diseases Research Group, St George's University of London, Cranmer Terrace, London SW17 0RE, UK. mike.sharland@stgeorges.nhs.uk.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.affiliation: Antimicrobial Resistance Programme, Public Health England, London NW9 5EQ, UK. susan.hopkins@phe.gov.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Hopkins
authors.affiliation: National Infection Service, Public Health England, London NW9 5EQ, UK. neil.woodford@phe.gov.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Woodford
authors.affiliation: Health Protection Analytical Team, Department of Health, Richmond House, 79 Whitehall, London SW1A 2NS, UK. philip.burgess@dh.gsi.gov.uk.
authors.forename: Philip
authors.initials: P
authors.lastname: Burgess
authors.affiliation: Health Protection Analytical Team, Department of Health, Richmond House, 79 Whitehall, London SW1A 2NS, UK. stephen.dobra@btinternet.com.
authors.forename: Stephen
authors.initials: S
authors.lastname: Dobra
keywords: Bayesian modelling; antibiotic resistance; risk assessment