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Updated: Jun 4, 2025

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Antimicrobial resistance-attributable mortality: a patient-level analysis.

Ioannis Baltas1,2, Timothy Miles Rawson3,4,5, Hamish Houston2

  • 1Infection, Immunity & Inflammation Department, UCL Institute of Child Health, London, UK.

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|December 20, 2024
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Summary
This summary is machine-generated.

Antimicrobial resistance (AMR) contributed to 4.2% of deaths in a UK hospital, with underreporting on death certificates. Intrinsic resistance mechanisms were as significant as acquired ones in AMR-attributable mortality.

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Area of Science:

  • Clinical Medicine
  • Infectious Diseases
  • Public Health

Background:

  • Estimating the patient-level impact of antimicrobial resistance (AMR) on mortality is complex.
  • This study aimed to quantify AMR-attributable deaths in a major UK teaching hospital.
  • Understanding AMR's role in mortality is crucial for public health strategies.

Purpose of the Study:

  • To characterize deaths attributable to antimicrobial resistance (AMR) at the patient level.
  • To assess the contribution of intrinsic versus acquired resistance mechanisms to AMR-attributable mortality.
  • To evaluate the accuracy of death certification in reflecting AMR as a cause of death.

Main Methods:

  • Retrospective analysis of all deceased patients in 2022 at a UK teaching hospital.
  • Independent review of patient records by two investigators using a novel patient-level definition for AMR-attributable deaths.
  • Analysis of resistance mechanisms (intrinsic vs. acquired) and time to effective treatment.

Main Results:

  • Antimicrobial resistance (AMR) was identified as the cause or contributing factor in 4.2% of all deaths (32/758).
  • Intrinsic resistance mechanisms (e.g., Enterococcus faecium, Enterobacterales with AmpCs, Pseudomonas aeruginosa) were responsible for the majority of AMR-attributable deaths.
  • Infection was significantly underreported on death certificates; AMR was not recorded as a cause of death in any case.

Conclusions:

  • Infection and AMR are significant contributors to mortality, but often underreported in death certifications.
  • In settings with low antimicrobial resistance incidence, intrinsic resistance plays a crucial role in AMR-attributable mortality, comparable to acquired resistance.
  • Accurate recording of infection and AMR on death certificates is essential for understanding their true impact on public health.