Population-level Analysis of Public Health Surveillance and Global Progress to Estimate the Burden of Antimicrobial Resistance Open Access

Kozuch, Michael (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/d791sh23b?locale=en


Purpose: Gaps remain in our ability to understand and quantify the scope of antimicrobial resistance (AMR). To assess the intersection between public health surveillance (PHS) and the global burden of disease associated with AMR, data were examined to capture the unique context within each country reporting to the Global Antimicrobial Resistance Surveillance System (GLASS). This investigation addressed whether two priority pathogens, K. pneumonia and E. coli, with demonstrated resistance in humans, animals, and the environment, exerted detectable effects at the national level.

Methods: Data in this ecological study were obtained using multiple, publicly available datasets from 2018. Countries were grouped by Human Development Index (HDI). Burden was measured using disability adjusted life years (DALYs) occurring from all causes. Questions from the Tripartite Antimicrobial Resistance Country Self-Assessment Survey capturing multi-sectoral approaches and country progress on national action plans (NAPs) on AMR were dichotomized in the analysis. Resistance profiles for K. pneumoniae and E. coli were calculated using the mean proportion of resistant antimicrobial susceptibility testing (AST) results by antibiotic-pathogen pair. Linear regression models were used to examine the relationship between markers of AMR and country-level disability burden.

Results: Data were available from 52 countries reporting to GLASS: 13 (25%) had low or medium HDI, 10 (19%) had high HDI, and 29 (56%) had very high HDI. The regression for Model 1 of 4 showed a significant positive association between the proportion of resistant K. pneumoniae ASTs and the rate of all-cause DALYs per 100,000 populations (β = 154.9; 95% CI: 30.6, 279.1). Reductions in burden were observed in countries reporting multisectoral AMR working groups (β = -10731.0; 95% CI: -17263.1, -4198.9) or with developed NAPs on AMR (β = -6292.1; 95% CI: -11832.7, -751.5).

Conclusion: The proportion of resistant K. pneumoniae and AMR national strategies are associated with the country-level burden of disease. Despite its potential predictive value, the proportion of resistant E. coli did not exert a discernable effect. Particularly during the scale-up of global efforts in AMR surveillance, our framework synthesizes the relationship between population-level factors, AMR, and risk of disability.

Table of Contents


Introduction 1

Methods 5

Results 7

Discussion 9



Table 1. 19

Table 2. 20

Table 3a. 21

Table 3b. 22


Figure 1a. 23

Figure 1b. 24


Appendix A 25

Appendix B 26


Final Search Statements 29

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