Economic consequences of antimicrobial resistance

In the past two decades, a dramatic increase in the frequency and prevalence of antimicrobial-resistant pathogens has challenged clinicians and researchers.

A review of the literature was conducted. Available data identifying the costs and consequences of resistance are summarized while the issues and limitations of research assessing the economics of resistance are acknowledged.

Microbial resistance is a complex, multifactorial phenomenon, but the single most powerful influence is antimicrobial use. Treatment guidelines, clinical pathways, and other directives exert widespread influences on individual selection of antimicrobial agents. However, use of an empiric regimen that does not provide effective coverage, or a targeted regimen that is dosed too low to provide optimal therapy, will delay eradication of the pathogen, increase the potential for resistance to emerge, extend and increase morbidity, and expose the patient to an increased risk of mortality. Coincident with these untoward clinical events are economic consequences secondary to increased duration of treatment, and for some, an extended duration of hospitalization.

Resistant gram-negative and gram-positive bacteria have been associated with increased direct medical costs ranging from several thousand dollars to tens of thousands of dollars per patient.