Predicting sepsis mortality into an era of pandrug-resistant E. coli through modeling

Abstract

Infections caused by antibiotic-resistant bacteria are increasingly frequent, burdening healthcare systems worldwide. As pathogens acquire resistance to all known antibiotics – i.e., become pan-resistant – treatment of the associated infections will become exceedingly difficult. We hypothesized that the emergence of pan-resistant bacterial pathogens will result in a sharp increase in human mortality. We tested this hypothesis by modeling the impact of a single hypothetical pan-resistant Escherichia coli strain on sepsis deaths in the United States. We used long-term data on sepsis incidence, mortality rates, strain dynamics, and treatment outcomes to parameterize a set of models encompassing a range of plausible future scenarios. All models accounted for historical and projected temporal changes in population size and age distribution. The models suggest that sepsis deaths could increase 18- to 46-fold within 5 years of the emergence of a single pan-resistant E. coli strain. This large and rapid change contrasts sharply with the current expectation of gradual change under continuing multidrug-resistance. Failure to prevent the emergence of pan-resistance would have dire consequences for public health. Antibiotic-resistant bacteria are an increasing risk to public health. As bacteria become resistant to all known antibiotics – i.e., become pan-resistant – treatment of infections will become extremely difficult. We hypothesized that the appearance of pan-resistant bacteria will result in a sharp increase in mortality. We tested this hypothesis using computer and mathematical modeling to see how a single hypothetical pan-resistant type of bacteria would impact deaths in the United States. Drawing from existing long-term data, deaths from infection in the general population could increase dramatically within 5 years of the emergence of a single pan-resistant type of common bacteria. Failing to prevent the emergence of pan-resistance would have dire consequences for public health. Koch et al. model scenarios of emergence of a single pan-resistant Escherichia coli strain in the United States. Findings suggest dire mortality outcomes and highlight the importance of measures to prevent the emergence of antimicrobial resistance.