This study provides an updated, systematic review and meta-analysis to determine the true effect size of resistant infections on economic and clinical outcomes. It also evaluates methodologies used in ABR economic literature, offering recommendations for improving future research. Following PRISMA guidelines, 11,252 articles published between 2000 and 2022 were reviewed from several databases and were included studies if they reported the economic costs of Antibiotic resistance (ABR) in humans and compared resistant with susceptible infections. Meta-analyses were conducted using random intercept models; standardised mean difference (SMD) was used for length of stay, and odds ratio (OR) for mortality. Results showed that 73% of the studies were conducted in high-income economies, the majority were performed at tertiary care settings (71%) and 67% employed only a hospital perspective. The available evidence indicated that the attributable cost of resistant infections ranged from EUR 2022 − 21,629 to EUR 2022 74,452 per patient episode (with Pseudomonas spp. causing the highest costs). The majority of studies (93%) found that patients with ABR incurred higher costs than their susceptible counterparts (72% report statistically significantly higher costs). Results from meta-analysis indicated that, on average, the excess in hospital stay attributable to resistant infections was 8.72 days (95% confidence interval (CI) and the odds of premature death were significantly higher in the resistance group, with a risk increase of 65% .The findings of this study take the first steps in providing reliable evidence; they could be valuable to researchers, policymakers and clinicians involved in ABR control and health promotion across countries.

This review examined methodologies used to cost the impact of antimicrobial resistance (AMR) infections in humans from household and health system perspectives. Although extensive research has been conducted on the clinical AMR burden in low- and middle-income countries (LMICs) in terms of prevalence and other drivers of antimicrobial resistance, there is increased misuse and overuse of antibiotics which increases the risk of AMR infections compared to high-income countries. The authors conducted a systematic review of studies searched in PubMed and other electronic databases. Only studies from LMICs were included. Using PRISMA, 2542 papers were screened at the title and abstract levels, of which 148 were retrieved for full-text review. Of these, 62 articles met the inclusion criteria. The articles had a quality assessment score averaging 85%, ranging from 63 to 100%. Most studies, 13, were from China (21%), followed by 8 from South Africa (13%). Tuberculosis (TB), general bacterial, and nosocomial infection costs are the most studied, accounting for 40%, 39%, and 6%, respectively with TB common in South Africa than the rest of the countries. Overall, the use of descriptive statistics without justification, limited consideration for potential data challenges, including confounders, and short-term horizons suggest that the full AMR cost burden in humans in LMICs has not been well accounted for. While the resources to conduct such cost studies are limited, the use of modelling costs via regression techniques while adjusting for cofounding could help maximize robustness and better estimate the vast and varied burden derived directly and indirectly from AMR

In this supplement, the authors evaluated existing evidence for the measurement of health-related quality of life (HRQoL) in common bacterial syndromes to determine whether the existing measures are “fit-for-purpose.” Through systematic literature reviews, the authors assessed the use of HRQoL measures in pneumonia, urinary tract infections, skin infections, and intra-abdominal infections. Another paper presents a secondary analysis of qualitative research in patients with bloodstream infections reported by source of infection. Another manuscript discusses the process of inter-agency collaboration on patient-centred drug development for infectious diseases. One manuscript describes research methods for developing, interpreting, and analysing endpoints in clinical trials and provides definitions for terms used in the supplement. The authors’ evaluations of current evidence elucidate several challenges and opportunities for measuring HRQoL in infectious diseases studies and clinical practice