A risk assessment of antibiotic pan-drug-resistance in the UK: Bayesian analysis of an expert elicitation study

Daniel Carter, André Charlett, Stefano Conti, Julie V. Robotham, Alan P. Johnson, David M. Livermore, Tom Fowler, Mike Sharland, Susan Hopkins, Neil Woodford, Philip Burgess, Stephen Dobra

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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 6,800 (95% CrI: 400-58,600) and 22,800 (95% CrI: 1,500-160,000), respectively; corresponding estimates of excess deaths were 1,900 (95% CrI: 0-23,000) and 6,400 (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.
Original languageEnglish
Article number9
JournalJournal of Antibiotics
Issue number1
Publication statusPublished - 7 Mar 2017


  • Antibiotic resistance
  • Bayesian modelling
  • risk assessment

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