The PrIMAVeRa project proudly announces the simultaneous publication of two informative systematic reviews in Clinical Microbiology and Infection that help provide much-needed clarity around the multifaceted challenge of Antimicrobial Resistance (AMR). A third is in the last stages and will hopefully be published soon. The systematic reviews are accompanied by an editorial commenting on the quality and availability of the identified AMR burden data️.➡️ Synthesizing pathogen- and infection-specific estimates of the burden of antimicrobial resistance in Europe for health-technology assessment: Gaps, heterogeneity, and bias.
The three systematic reviews provide a comprehensive insight into the current evidence base of the impact of AMR, including frequency measures, health outcomes, and economic repercussions. Detailed AMR burden data for specific pathogen-infection combinations is essential to decide upon target pathogens and target patient groups for novel vaccines and monoclonal antibodies to battle AMR in Europe.
All three systematic reviews focused on 6 key pathogens and associated relevant infection types.
The first systematic review, led by Prof Evelina Tacconelli, on AMR frequency measures screened 6617 articles, including 273 epidemiological and clinical studies and 57 surveillance systems from 3 European countries, pooling antimicrobial resistance frequency measures defined as resistance percentage, prevalence, incidence, and incidence density. The data on bloodstream infections indicated that in hospital setting third generation cephalosporin-resistant and carbapenem-resistant Enterobacterales in Southern and Central East Europe have the highest resistance rates while luck of data for other settings such as long-term care facilities and community still represent an important knowledge gap that needs to be filled. ➡️Frequency of bloodstream infections caused by six key antibiotic resistant pathogens for prioritisation of research and discovery of new therapies in Europe: a systematic review
For the first time, these comprehensive investigations enable data-driven prioritisation of pathogen selection for vaccine development to effectively reduce the burden of antimicrobial resistance in Europe - Dr Marlieke de Kraker.
The second systematic review, led by Dr Marlieke de Kraker, focused on excess health risks and identified 98 articles, indicating that carbapenem-resistant Klebsiella pneumoniae had the largest excess mortality in patients with bloodstream infections. For other infection types, or other outcomes, which could be more relevant to patients, little data was identified.➡️ A systematic review on the excess health risk of antibiotic-resistant bloodstream infections for six key pathogens in Europe
The third systematic review, led by Dr Julie Robotham, identified evidence on the incremental economic impact of drug-resistant infections. Most evidence was available for third-generation cephalosporin-resistant Escherichia coli and methicillin-resistant Staphylococcus aureus bloodstream infections. While it could be shown that AMR increased hospital length of stay for these infections, which is a large part of costs associated with hospital admission, other relevant economic outcomes were lacking. This publication is currently under revision.
The PrIMAVeRa project prepared systematic review protocols (PROSPERO: CRD42022312795, CRD42022322586, CRD42022331400) and meticulously reviewed the available evidence across scientific literature, grey literature, and websites. The diligent process involved an extensive quality assessment of available evidence and, where feasible, the conduct of meta-analyses to determine the key pathogen-infection combinations that underpin the burden of AMR. By doing so, PrIMAVeRa aims to arm the European community with a nuanced understanding of AMR, enabling more informed and effective strategies in combating this global challenge.
The publication of these systematic reviews during World AMR Awareness Week (WAAW) aims to serve as a reminder of the urgent need for global cooperation and innovative solutions to address the knowledge gaps and the challenges posed by AMR. For those passionate about combatting AMR, these systematic reviews are an invaluable resource: representing a snapshot of the currently available data that could help shape the future of healthcare research and marking an important milestone in our quest for a healthier, more resilient future.
For more information, please visit the PrIMAVeRa project website (www.primavera-amr.eu) and access the interactive webpages dedicated to the systematic review results hosted by the ECRAID-Base EPI-Net (https://epi-net.eu/primavera/about/burden-of-antimicrobial-resistance/).
Romina Di Marzo
Communications and Advocacy Manager
About the PrIMAVeRa project: The PrIMAVeRa project, coordinated by the European Vaccine Initiative (EVI) and led by Dr. Marc Bonten of University Medical Center Utrecht as Project Scientific Lead, and Dr. Venanzio Vella of GlaxoSmithKline as Project Industry Lead, is a collaborative, interdisciplinary initiative dedicated to understanding and addressing the growing threat of Antimicrobial Resistance (AMR). The project's ultimate goal is to pave the way for informed decision-making, policy formulation, and strategic investment in vaccines and monoclonal antibodies to combat AMR.
This work has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 101034420 (PrIMAVeRa). This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. This communication reflects the author's view, and neither IMI nor the European Union, EFPIA, or any Associated Partners are responsible for any use that may be made of the information contained herein.