Original scientific paper
https://doi.org/10.3325/cmj.2023.64.272
The burden of bacterial antimicrobial resistance in Croatia in 2019: a country-level systematic analysis
Tomislav Meštrović
; University North, University Centre Varaždin, Varaždin, Croatia
*
Kevin Shunji Ikuta
; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Lucien Swetschinski
; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Authia Gray
; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Gisela Robles Aguilar
; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Chieh Han
; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Eve Wool
; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Anna Gershberg Hayoon
; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Christopher J. L. Murray
; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Mohsen Naghav
; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
* Corresponding author.
Abstract
Aim To deliver the most wide-ranging set of antimicrobial
resistance (AMR) burden estimates for Croatia to date.
Methods A complex modeling approach with five broad
modeling components was used to estimate the disease
burden for 12 main infectious syndromes and one residual
group, 23 pathogenic bacteria, and 88 bug–drug combinations. This was represented by two relevant counterfactual scenarios: deaths/disability-adjusted life years (DALYs)
that are attributable to AMR considering a situation where
drug-resistant infections are substituted with sensitive
ones, and deaths/DALYs associated with AMR considering a scenario where people with drug-resistant infections
would instead present without any infection. The 95% uncertainty intervals (UI) were based on 1000 posterior draws
in each modeling step, reported at the 2.5% and 97.5% of
the draws’ distribution, while out-of-sample predictive validation was pursued for all the models.
Results The total burden associated with AMR in Croatia
was 2546 (95% UI 1558–3803) deaths and 46 958 (28,033–
71,628) DALYs, while the attributable burden was 614 (365–
943) deaths and 11 321 (6,544–17,809) DALYs. The highest
number of deaths was established for bloodstream infections, followed by peritoneal and intra-abdominal infections and infections of the urinary tract. Five leading pathogenic bacterial agents were responsible for 1808 deaths
associated with resistance: Escherichia coli, Staphylococcus
aureus, Acinetobacter baumannii, Klebsiella pneumoniae,
and Pseudomonas aeruginosa (ordered by the number of
deaths). Trimethoprim/sulfamethoxazole-resistant E coli
and methicillin-resistant S. aureus were dominant pathogen-drug combinations in regard to mortality associated
with and attributable to AMR, respectively.
Conclusion We showed that AMR represented a substantial public health concern in Croatia, which reflects global trends; hence, our detailed country-level findings may
fast-track the implementation of multipronged strategies
tailored in accordance with leading pathogens and pathogen-drug combinations.
Keywords
Hrčak ID:
331842
URI
Publication date:
31.8.2023.
Visits: 199 *