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Modeling the Impact of Antimicrobial Resistance on Medical Preparedness and Response for a Nuclear or Radiological

Andrew J Phipps1,2, Sue K Cammarata1,2, Julia A Falvey1,3

  • 1Center for Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), U.S. Department of Health and Human Services (HHS), Washington, DC, USA.

Disaster Medicine and Public Health Preparedness
|September 10, 2025
PubMed
Abstract

Insights

Rising antimicrobial resistance (AMR) poses a significant threat to mass casualty incident response. A nuclear detonation could lead to one-third of infected casualties facing antibiotic treatment failure due to AMR.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Disaster Medicine

Background:

  • Antimicrobial resistance (AMR) is a growing global health concern.
  • Mass casualty incidents, such as nuclear detonations, present unique challenges for healthcare systems.
  • Secondary bacterial infections are a common complication in mass casualty scenarios.

Purpose of the Study:

  • To assess the impact of AMR on medical preparedness for a nuclear detonation in the U.S.
  • To model the number of casualties with secondary bacterial infections and the risk of antibiotic treatment failure.

Main Methods:

  • A simulation model was used to estimate casualties from a 100-kiloton nuclear detonation in a U.S. metropolitan area.
  • Antibiotic resistance rates for eight key bacterial pathogens were obtained from the SENTRY Microbiology Visualization Platform.

Main Results:

  • Up to 65% of casualties could develop secondary bacterial infections requiring antibiotics.
  • The increasing burden of AMR in the U.S. could lead to treatment failure in up to one-third of infected casualties.
  • Antimicrobial resistance significantly complicates the management of infections in mass casualty incidents.

Conclusions:

  • The growing threat of AMR poses a substantial challenge to effective medical response during mass casualty incidents.
  • Preparedness strategies must account for the impact of antimicrobial resistance to protect lives and ensure successful treatment outcomes.
Keywords:
antimicrobial resistancemodelingnuclear detonationradiation exposure

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