Antimicrobial resistance trends, predictors, and burden in England : a retrospective study using the Clinical Practice Research Datalink from 2015-2021

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Taie, Amer and Gheorghe, Maria and Amos, James and Morton, Alec and Gordon, Jason and Jenkins, Nia C. and Padgett, Thomas E. and Hollinghurst, Joe and Taylor, Gemma (2025) Antimicrobial resistance trends, predictors, and burden in England : a retrospective study using the Clinical Practice Research Datalink from 2015-2021. International Journal of Antimicrobial Agents, 66 (3). 107535. ISSN 0924-8579 (https://doi.org/10.1016/j.ijantimicag.2025.107535)

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Abstract

Evidence describing the burden of antimicrobial resistance (AMR) to healthcare systems is essential to inform healthcare policy to tackle AMR. This study aims to investigate trends, predictors, and clinical and economic burden of AMR within the English National Health Service. Retrospective cohort study assessing 1,036,850 patients diagnosed with an infection as a hospital inpatient linked to the Clinical Practice Research Datalink within England between 2015 and 2021. Resistance was identified with specific ICD-10 codes. Predictors of AMR were determined using logistic regression and extreme gradient boosting trees. A 1:1 propensity score matched cohort of 78,153 patients with an AMR infection compared to those without was created. Incidence Rate Ratios (IRRs) were estimated between those two groups for hospital length of stay (from admission to discharge), re-hospitalisations within 1-year of diagnosis of infection, and total hospital costs. Acceleration Factors (AFs) were estimated for time to all-cause mortality and first re-hospitalisation. Between 2015 and 2020, AMR had a proportional increase of 10%. Resistant infections are associated with an additional 9.2 days length of stay and an additional hospitalisation cost of £3,441 per patient compared with infections not reported as resistant. Within 1, 3, and 5-years 3.2%, 6.3%, and 7.3% more patients with AMR infections died and 7.8%, 5.3%, and 3.6% more patients were re-hospitalised, respectively. AFs indicated patients with AMR infections die 27% earlier and re-hospitalised 26% earlier than those with non-AMR infections. AMR is a significant and growing threat to healthcare; this analysis suggests AMR is associated with significant excess of healthcare use and increased mortality and readmission.

ORCID iDs

Taie, Amer, Gheorghe, Maria, Amos, James, Morton, Alec ORCID logoORCID: https://orcid.org/0000-0003-3803-8517, Gordon, Jason, Jenkins, Nia C., Padgett, Thomas E., Hollinghurst, Joe and Taylor, Gemma;
CORE (COnnecting REpositories)