Burden of Antimicrobial Resistance: Compared to What?

IF 5.2 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Epidemiologic Reviews Pub Date : 2022-01-14 DOI:10.1093/epirev/mxab001
Marlieke E A de Kraker, Marc Lipsitch
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引用次数: 21

Abstract

The increased focus on the public health burden of antimicrobial resistance (AMR) raises conceptual challenges, such as determining how much harm multidrug-resistant organisms do compared to what, or how to establish the burden. Here, we present a counterfactual framework and provide guidance to harmonize methodologies and optimize study quality. In AMR-burden studies, 2 counterfactual approaches have been applied: the harm of drug-resistant infections relative to the harm of the same drug-susceptible infections (the susceptible-infection counterfactual); and the total harm of drug-resistant infections relative to a situation where such infections were prevented (the no-infection counterfactual). We propose to use an intervention-based causal approach to determine the most appropriate counterfactual. We show that intervention scenarios, species of interest, and types of infections influence the choice of counterfactual. We recommend using purpose-designed cohort studies to apply this counterfactual framework, whereby the selection of cohorts (patients with drug-resistant, drug-susceptible infections, and those with no infection) should be based on matching on time to infection through exposure density sampling to avoid biased estimates. Application of survival methods is preferred, considering competing events. We conclude by advocating estimation of the burden of AMR by using the no-infection and susceptible-infection counterfactuals. The resulting numbers will provide policy-relevant information about the upper and lower bound of future interventions designed to control AMR. The counterfactuals should be applied in cohort studies, whereby selection of the unexposed cohorts should be based on exposure density sampling, applying methods avoiding time-dependent bias and confounding.

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抗菌素耐药性负担:与什么相比?
对抗菌素耐药性(AMR)的公共卫生负担的日益关注提出了概念上的挑战,例如确定多药耐药生物体造成的危害程度,或如何确定这种负担。在此,我们提出了一个反事实框架,并为协调研究方法和优化研究质量提供了指导。在抗菌素耐药性负担研究中,采用了两种反事实方法:耐药感染的危害相对于相同药敏感染的危害(易感感染反事实);以及相对于这种感染被预防的情况(无感染反事实),耐药感染的总危害。我们建议使用基于干预的因果方法来确定最合适的反事实。我们表明干预方案,感兴趣的物种和感染类型影响反事实的选择。我们建议使用目的设计的队列研究来应用这种反事实框架,据此,队列(耐药患者、药敏感染患者和无感染患者)的选择应基于暴露密度抽样与感染的时间匹配,以避免有偏估计。考虑到竞争项目,优先考虑生存方法的应用。最后,我们主张使用无感染和易感感染反事实来估计抗菌素耐药性的负担。由此得出的数字将提供有关未来旨在控制抗生素耐药性的干预措施上限和下限的政策相关信息。反事实应应用于队列研究,即选择未暴露的队列应基于暴露密度抽样,采用避免时间相关偏差和混淆的方法。
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来源期刊
Epidemiologic Reviews
Epidemiologic Reviews 医学-公共卫生、环境卫生与职业卫生
CiteScore
8.10
自引率
0.00%
发文量
10
期刊介绍: Epidemiologic Reviews is a leading review journal in public health. Published once a year, issues collect review articles on a particular subject. Recent issues have focused on The Obesity Epidemic, Epidemiologic Research on Health Disparities, and Epidemiologic Approaches to Global Health.
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