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Excess infections due to antimicrobial resistance: the "Attributable Fraction"
1Carney Hospital, Boston, MA, 02124, USA. Michael_Barza_MD@cchcs.org
Abstract:
Antimicrobial use causes a transient decrease in an individual's resistance to colonization by noncommensal bacteria ("competitive effect") and increases the likelihood of infection upon exposure to a foodborne pathogen. The additional "selective effect" of antimicrobial resistance results in a >3-fold increase in vulnerability to infection by an antimicrobial-resistant pathogen among individuals receiving antimicrobial therapy for unrelated reasons. Combining the increase in vulnerability to infection with the prevalence of taking an antimicrobial agent, it is possible to estimate the attributable fraction, or the number of excess infections that occurred as a result of the unrelated use of an antimicrobial agent to which the pathogen was resistant. Calculations based on estimates of the annual infection rates and attributable fractions of infections with nontyphoidal Salmonella and Campylobacter jejuni suggest that resistance to antimicrobial agents results annually in an additional 29,379 nontyphoidal Salmonella infections, leading to 342 hospitalizations and 12 deaths, and an additional 17,668 C. jejuni infections, leading to 95 hospitalizations.
Insights
Antimicrobial use increases infection risk by weakening the body's defenses and promoting resistance. This leads to thousands of excess Salmonella and Campylobacter infections annually due to antimicrobial resistance.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Antimicrobial use can compromise the immune system's ability to resist pathogens.
- Antimicrobial resistance exacerbates infection risk, particularly from resistant strains.
Purpose of the Study:
- To quantify the excess infections and hospitalizations caused by antimicrobial resistance.
Main Methods:
- Calculated attributable fractions based on infection rates and antimicrobial use prevalence.
- Estimated excess infections for specific foodborne pathogens.
Main Results:
- Antimicrobial resistance leads to an estimated 29,379 additional nontyphoidal Salmonella infections annually.
- An estimated 17,668 additional Campylobacter jejuni infections occur annually due to antimicrobial resistance.
Conclusions:
- Unrelated antimicrobial use significantly contributes to the burden of foodborne bacterial infections.
- Antimicrobial resistance results in substantial excess morbidity and mortality from Salmonella and Campylobacter infections.