Lifting the Medical and Economic Burden of AMR in the US

Antimicrobial resistance (AMR) continues to place a heavy medical and economic burden on healthcare systems while impacting patient care. Efforts like the Pasteur Act demonstrate the growing national interest from policymakers and advocacy groups in preventing the spread of AMR and mitigating its economic impacts.

Investing in comprehensive antimicrobial stewardship (AMS) efforts is the best way to protect patients’ lives and reduce costs associated with extended hospital stays caused by resistant organisms. The CDC Core Elements of Hospital Antibiotic Stewardship recognizes the role of diagnostics in optimizing antibiotic therapy and ensuring patients receive timely care.¹ Rapid diagnostics form a core element of any successful AMS program and will be instrumental in accomplishing national stewardship initiatives.

The CDC and its academic partners estimate that the impact of AMR on US healthcare systems outlay an additional $4.6 billion per year, caused by the 2.8 million resistant infections that Americans face on an annual basis.² These additional costs often come from the extra equipment, medical staff, and extended length of stay for patients who need treatment for more complicated infections. The COVID-19 pandemic only exacerbated the issue³ by depleting healthcare resources and fueling the rise of resistant superbugs across the nation. AMR threatens the safety of modern medicine for patients while placing a heavy economic burden on healthcare systems already stretched thin in the wake of COVID-19.

Addressing a problem of this scale requires a collaborative effort from government officials, public health institutions, industry partners, academics, and healthcare providers. The bipartisan Pasteur Act calls for a new model of antibiotic drug development as well as increased funding to support resource-challenged stewardship programs.

The Pasteur Act would establish a subscription-style model offering an upfront payment to research and develop a pipeline of novel antibiotics. The act also recognizes the need to bolster stewardship efforts to ensure that both existing antibiotics and new drugs will be used appropriately. Collecting and monitoring AMR data from around the country and reporting on antibiotic use using advanced analytics is key to measuring the success of stewardship programs and directing future AMS efforts.

Rapid diagnostics and data-driven analytic tools play a major role in improving AMS, producing cost savings, and protecting patient's lives from resistant infections. For example, using rapid diagnostics for the detection and treatment of bloodstream infections (BSI) represents one of many ways these tools contribute to AMS. In a study published in Clinical Infectious Diseases,⁴ a systematic review of 31 studies including over 5000 patients showed that rapid diagnostics for BSI reduced time to effective therapy by five hours and decreased hospital length of stay by almost two-and-a-half days. Another study from Open Forum Infectious Diseases⁵ showed that using a diagnostic bundle for uncomplicated gram-negative BSIs decreased the total average hospital cost per patient by 27%.

Research also demonstrates the economic value of multiplex PCR testing for AMS. PCR testing cut the length of stay by an average of 1.2 days for those with suspected CNS (central nervous system) infections like meningitis and encephalitis in an Antibiotics journal study.⁶ Additionally, a meta-analysis⁷ including over 17,000 adult patients who received PCR testing in acute respiratory tract infections showed a decreased length of stay at the same time that appropriate antiviral use increased by 25%. Diagnostics have the potential to contribute to cost savings for other types of resistant infections because of the key role these tools play in AMS in supporting clinical decision-making and optimizing antibiotic use.

Individuals and organizations across the public and private sectors realize the growing medical and economic impact of AMR. This critical issue will only grow larger without serious intervention. Now is the time for Congress to prioritize national efforts such as the Pasteur Act, which was introduced in both the House and Senate in April 2023. Over 200 organizations officially support the Pasteur Act. This is an important step in the right direction in combating the rise of AMR. Diagnostic data has the power to bring everyone together to understand the scope and spread of resistance patterns, to direct antibiotic use for optimal patient care, and to assist in reducing costs associated with best stewardship practices.

References

1. Antibiotic Prescribing and Use. CDC. September 7, 2023. Accessed December 6, 2023. https://www.cdc.gov/antibiotic-use/core-elements/hospital.html

2. CDC Partners Estimate Healthcare Cost of Antimicrobial resistant Infections. CDC. November 23, 2021. Accessed December 6, 2023. https://www.cdc.gov/drugresistance/solutions-initiative/stories/partnership-estimates-healthcare-cost.html

3. COVID-19: U.S. impact on antimicrobial resistance, special report 2022. CDC. June 2022. Accessed December 6, 2023. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.cdc.gov/drugresistance/pdf/covid19-impact-report-508.pdf

4. Timbrook TT, Morton JB, McConeghy KW, Caffrey AR, Mylonakis E, LaPlante KL. The Effect of Molecular Rapid Diagnostic Testing on Clinical Outcomes in Bloodstream Infections: A Systematic Review and Meta-analysis. Clin Infect Dis. 2017;64(1):15-23. doi:10.1093/cid/ciw649

5. Erickson RM, Tritle BJ, Spivak ES, Timbrook TT. Impact of an Antimicrobial Stewardship Bundle for Uncomplicated Gram-Negative Bacteremia. Open Forum Infect Dis. 2019;6(12):ofz490. Published 2019 Nov 13. doi:10.1093/ofid/ofz490

6. Hueth KD, Thompson-Leduc P, Totev TI, Milbers K, Timbrook TT, Kirson N, Hasbun R. Assessment of the Impact of a Meningitis/Encephalitis Panel on Hospital Length of Stay: A Systematic Review and Meta-Analysis. Antibiotics. 2022; 11(8):1028. https://doi.org/10.3390/antibiotics11081028

7. Clark TW, Lindsley K, Wigmosta TB, et al. Rapid multiplex PCR for respiratory viruses reduces time to result and improves clinical care: Results of a systematic review and meta-analysis. J Infect. 2023;86(5):462-475. doi:10.1016/j.jinf.2023.03.005