Antimicrobial Resistance Strategy Research Articles

Factors Influencing Increased Anti-Microbial Resistance and Mitigation Strategies Used Among People Living with HIV Aids Visiting Rwanda Military Hospital

Factors Influencing Increased Anti-Microbial Resistance and Mitigation Strategies Used Among People Living with HIV Aids Visiting Rwanda Military Hospital

Perspectives on the Regional Strategy for Implementation of National Action Plans on Antimicrobial Resistance in the WHO African Region.

Background: The WHO Regional Office for Africa developed a Member States (MS)-endorsed regional strategy to fast-track the implementation of MS' national action plans (NAP) on Antimicrobial resistance (AMR). This study explored the perspectives of AMR's national focal points in MS on the implementation of the priority interventions of the regional strategy in their countries. Methods: An online survey consisting of ratings and discussions covering the implementation of the six priority interventions was conducted. Sums of the scores per priority intervention were obtained, and their percentage to the total possible scores were calculated to categorize the implementation as inadequate (0-25%), basic (26-50%), intermediate (51-75%), or advanced (76-100%). Results: Thirty-six of the forty-seven national AMR focal points responded to the survey between 12 November 2023 and 8 January 2024. The implementations were rated as 37-62% (basic-to-intermediate), with the multisectoral coordination and collaboration committee receiving the highest overall rating (62%, 421/684), while the promotion of sustainable investment for the NAP on AMR received the least overall rating (37%, 257/700). The focal points mainly recommended awareness campaigns, capacity building, and regulations and guidelines to improve the implementation of the AMR strategy. Conclusions: The survey revealed a need to enhance awareness campaigns, support the establishment and functioning of AMR evaluation and monitoring systems, and build the capacity of AMR staff with cost-benefit analysis and budgeting skills. It also showed the necessity to improve awareness and conduct education on AMR, streamline evidence generation through One Health Surveillance systems, integrate initiatives to reduce hospital-acquired infections in the antimicrobial stewardship programs, and enhance regulations and guidelines to optimize the use of antimicrobials.

Identification of genes used by Escherichia coli to mitigate climatic stress conditions

IntroductionIncreasing temperature and elevated atmospheric carbon dioxide levels could impact the survival of stress-adapted bacteria. Method and resultsIn this study, RNA sequencing was performed to quantify Escherichia coli BL21 (DE3) gene expression in culture media under environmental temperature (27 °C and 42 °C) and carbon dioxide (0.2 % and 6 % v/v) conditions. Differential gene expression analysis between low temperature and different carbon dioxide conditions revealed up-regulated genes such as ldtC and bioA, optimising cell wall integrity and nutrient uptake. While, the downregulation of genes such as malK suggested a metabolic adaptation. Low temperature and high carbon dioxide levels enhanced bacterial tolerance to environmental stress. Under optimal temperatures, Escherichia coli adapts through various metabolic pathways while engaging in different processes at low temperatures and carbon dioxide levels, with temperature having a greater impact on gene expression than carbon dioxide levels. This study shows that complex metabolic activities are activated when both temperatures and carbon dioxide levels are combinsed, affecting antimicrobial resistance, nutrient acquisition, and adaptation strategies. ConclusionEach condition exhibited mechanisms to enhance cellular resilience and adaptation to stress, focusing on cellular integrity, optimising energy utilisation, and activating stress response pathways. Impact statementThe findings stress the importance of continued research to understand the implications of climate change on microbial transcriptomes comprehensively.

Mycoplasma genitalium Infections Among Participants in an HIV Pre-exposure Prophylaxis Program in Hanoi, Vietnam.

Mycoplasma genitalium causes a sexually transmitted infection and is also emerging as an important antimicrobial resistant pathogen. Data on M. genitalium infections among men who have sex with men (MSM) in low-resource settings are sparse. From January to December 2022, participants in an HIV pre-exposure prophylaxis (PrEP) program in Hanoi, Vietnam were enrolled into the study. Demographic, behavioral, and clinical characteristics were collected. Self-collected urine, rectal, and pharyngeal specimens were tested for M. genitalium using the Alinity m STI Assay (Abbott Molecular, USA). Univariate and multivariate logistic regression were performed to assess for factors associated with infections. Among 477 participants, the median age was 25.3 years (21.7-29.6) and 92.2% (n = 440) identified as MSM; 48.6% had ≥2 sex partners and 38.1% reported condomless anal sex in the prior month. The overall prevalence of M. genitalium infection was 10.9% (52/477); 7.3% (34/464) rectal, 3.2% (15/476) urethral, and 1.9% (9/476) pharyngeal. Infections were asymptomatic in 71.2% (37/52). Among those with M. genitalium , 30.7% (16/52) were co-infected with either Neisseria gonorrhoeae or Chlamydia trachomatis. Among those reporting rectal (n = 51) or urethral (n = 35) symptoms, but without C. trachomatis or N. gonorrhoeae co-infections, five (9.8%) had rectal infections and one (2.9%) had urethral infection. Participants with M. genitalium were more likely to be asymptomatic than participants without M. genitalium (adjusted odds ratio, 1.93; 95% confidence interval, 1.01-3.71). Mycoplasma genitalium infections were common among primarily MSM engaged in an HIV PrEP program in Vietnam. The prevalence was highest in rectal specimens and nearly three quarters of M. genitalium infections were asymptomatic. Testing for M. genitalium infections among those with symptoms is important to enable pathogen-directed therapy. Additional research on antimicrobial resistance and treatment strategies for M. genitalium in low-resource settings is needed.

Subclinical Mastitis of Buffaloes in Asia: Prevalence, Pathogenesis, Risk Factors, Antimicro-bial resistance, and Current Treatment Strategies

Subclinical Mastitis of Buffaloes in Asia: Prevalence, Pathogenesis, Risk Factors, Antimicro-bial resistance, and Current Treatment Strategies

The CRISPR/Cas system as an antimicrobial resistance strategy in aquatic ecosystems.

With the growing population, demand for food has dramatically increased, and fisheries, including aquaculture, are expected to play an essential role in sustaining demand with adequate quantities of protein and essential vitamin supplements, employment generation, and GDP growth. Unfortunately, the incidence of emerging/re-emerging AMR pathogens annually occurs because of anthropogenic activities and the frequent use of antibiotics in aquaculture. These AMR pathogens include the WHO's top 6 prioritized ESKAPE pathogens (nosocomial pathogens: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.), extended-spectrum beta lactases (ESBLs) and carbapenemase-producing E. coli, which pose major challenges to the biomagnification of both nonnative and native antibiotic-resistant bacteria in capture and cultured fishes. Although implementing the rational use of antibiotics represents a promising mitigation measure, this approach is practically impossible due to the lack of awareness among farmers about the interplay between antimicrobial use and the emergence of antimicrobial resistance (AMR). Nevertheless, to eradicate these 'superbugs,' CRISPR/Cas (clustered regularly interspersed short palindromic repeats/CRISPR associate protein) has turned out to be a novel approach owing to its ability to perform precise site-directed targeting/knockdown/reversal of specific antimicrobial resistance genes in vitro and to distinguish AMR-resistant bacteria from a plethora of commensal aquatic bacteria. Along with highlighting the importance of virulent multidrug resistance genes in bacteria, this article aims to provide a holistic picture of CRISPR/Cas9-mediated genome editing for combating antimicrobial-resistant bacteria isolated from various aquaculture and marine systems, as well as insights into different types of CRISPR/Cas systems, delivery methods, and challenges associated with developing CRISPR/Cas9 antimicrobial agents.

AntiMicro.ai: An Artificial Intelligence powered web application for predicting antibacterial/antifungal susceptibility and constructing personalized machine learning models

Background To train and develop machine learning models on the Pfizer antibacterial and antifungal datasets with subsequent deployment to an interactive Web Application. Methods We utilized R version 4.3.1 to perform descriptive analysis to obtain features/predictors. Python 3.10 libraries NumPy, Pandas, Scikit learn, Pycaret were used to train machine learning models. All these models were scored using area under the curve, recall, precision, F1, Kappa and the Mathews correlation coefficient. The best performing model was then deployed into a web application built on Streamlit after which deployment was done using GitHub and Streamlit cloud. A prototype android app was also developed using GoNative. Results The exploratory data analysis, S Aureus (17.2%) was the most common species however in the sub group analysis of the isolates with genotypic values, K Pneumoniae(48.2%) and E Coli (36.9%) were dominant. Amongst the fungi, Candida albicans (38.3%) and Candida glabrata (15.5%) were dominant. Feature selection was done using Shapley additive explanation plots. Using Extreme Gradient Boosting (XGBoost), we were able to achieve 99% and 97.8% AUC in the prediction of antibacterial and antifungal susceptibility respectively with minimal overfitting. Conclusions Decision tree based methods are a viable options of predicting antibacterial and antifungal drug resistance. When presented in visually appealing modes like web applications and android apps, it can be a useful guide to clinicians on initial treatment while awaiting definitive phenotypic testing. It can also be a surveillance tool that can craft antimicrobial resistance strategies.

Update About The Changes In Bacterial Resistance For Multiple Antibiotic In Patients With Urinary Tract Infection In Kerbala

Urinary tract infections (UTIs) caused by Escherichia coli (E. coli) are common and recurrent, particularly among females. Treatment often involves various antimicrobial agents, but rising resistance poses challenges. We conducted a study in Al-Hussein Medical City, Kerbala, enrolling 520 UTI patients from April 2022 to February 2023. Urine samples were tested for antimicrobial susceptibility. Results showed high resistance to most agents, except meropenem and levofloxacin. Our findings emphasize the urgent need for strategies to combat antimicrobial resistance in UTIs. Highlights: High resistance in UTI treatment observed. Urgent need for antimicrobial resistance strategies. Study reveals E. coli resistance patterns in Kerbala's medical setting. Keywords: Urinary tract infections, Escherichia coli, Antimicrobial resistance, Al-Hussein Medical City, Kerbala

Social Dimensions of Antimicrobial Resistance and an Anthropological Approach: Analytic Review

Purpose: The objective of this paper is to devise a comprehensive and layered framework to tackle antimicrobial resistance (AMR). It aims to weave together the strands of ethnomedicine, healthcare system analysis, and anthropological perspectives on illness, aligning with universal healthcare principles to encourage community participation and address the societal roots of health inequalities. The framework seeks to address AMR through a lens that views health disparities not merely as medical issues, but as complex phenomena shaped by cultural, social, and structural factors.
 Methodology: The research employs a single-case study design to synthesize and analyse interdisciplinary insights into AMR. This approach facilitates an in-depth understanding of how various elements, such as cultural beliefs, healthcare practices, and community dynamics, interact and influence the spread and management of AMR. By focusing on a single case, the study intends to meticulously document and interpret the nuanced interactions between these factors, providing a detailed narrative that captures the essence of the AMR challenge in a global health context. The study utilizes 66 varied references, such as journal articles, book excerpts, theses, reports, and websites, sourced from academic venues and the internet, published between 1946 and 2023.
 Findings: Through its investigation, the study presents a healthcare approach that marries the traditional wisdom of ethnomedicine with the precision of biomedicine, underscoring the significance of cultural competence in formulating AMR mitigation strategies. It dissects the intricate relationship between the three primary health sectors—popular, professional, and folk—and disentangles the sociocultural concepts of 'disease' and 'illness' as distinguished by medical anthropologists. The research calls for a reconceptualization of healthcare systems that goes beyond the biomedical model, advocating for an integration of the sociocultural, economic, and political dimensions that influence health and illness manifestations.
 Unique contribution to theory: This study's unique theoretical contribution lies in its interdisciplinary approach to health disparities and AMR. It proposes a model that balances the rigor of scientific research with the insights gleaned from traditional health practices, placing a premium on the dynamics of community involvement and the myriad influences on health. By doing so, it offers a more equitable, sustainable, and contextually relevant paradigm for health practices and policies. This paradigm shift is intended to provide actionable insights for policymakers and health practitioners, enabling them to devise strategies that are not only scientifically sound but also culturally sensitive and broadly applicable. The framework envisages a future where health interventions are tailored to the lived experiences of diverse populations, potentially transforming the landscape of global health and AMR strategy.

The threat of Antimicrobial Resistance in Developing Countries: Causes and Control Strategies

The causes of antimicrobial resistance (AMR) in developing countries are complex and may be rooted in practices of health care professionals and patients’ behavior towards the use of antimicrobials as well as supply chains of antimicrobials in the population. Some of these factors may include inappropriate prescription practices, inadequate patient education, limited diagnostic facilities, unauthorized sale of antimicrobials, lack of appropriate functioning drug regulatory mechanisms, and non-human use of antimicrobials such as in animal production. Considering that these factors in developing countries may vary from those in developed countries, intervention efforts in developing countries need to address the context and focus on the root causes specific to this part of the world. Here, we describe these health-seeking behaviors that lead to the threat of AMR and healthcare practices that drive the development of AMR in developing countries and we discuss alternatives for disease prevention as well as other treatment options worth exploring. Keywords: Antimicrobial resistance, Causes and Control Strategies

National action plans on antimicrobial resistance in Latin America: an analysis via a governance framework.

In 2015, the World Health Assembly adopted a global action plan (GAP) on antimicrobial resistance (AMR). Member states were encouraged to develop their own national action plans (NAPs) in alignment with the GAP. To-date, in systematic assessments of NAPs, the Latin American specific context has not been previously analysed. Here we examined 11 Latin American NAPs published between 2015 and 2021 using content analysis. We focused on two approaches: (1) alignment between the strategic objectives and actions defined in the GAP, and those outlined in the NAPs via a content indicator; and (2) assessment of the NAPs via a governance framework covering 'policy design', 'implementation tools' and 'monitoring and evaluation' areas. We observed a high alignment with the strategic objectives of the GAP; however, the opposite was observed for the corresponding actions. Our results showed that the governance aspects contained within coordination and participation domains were addressed by every Latin American NAP, whereas monitoring and assessment areas, as well as incorporating the environment, would need more attention in subsequent NAPs. Given that AMR is a global health threat and collective efforts across regions are necessary to combat it, our findings can benefit member states by highlighting how to strengthen the AMR strategies in Latin America, while also supporting global policy formulation.

Therapeutic proteins have the potential to become new weapons in the fight against antibiotic resistance

Humans are continually challenged to find new strategies to fight bacterial diseases due to the global health threat of antibiotic resistance. Conventional antibiotics, once hailed as miracle treatments, are progressively losing their effectiveness as drug-resistant bacteria continue to emerge, including multidrug-resistant (MDR) strains. An attractive approach to solving the antibiotic resistance problem is the investigation of other methods, such as therapeutic proteins. Here, we begin with a discussion of antimicrobial resistance and common strategies that bacteria employ to become resistant. Next, we discuss the potential use of antimicrobial peptides and monoclonal antibodies, two types of therapeutic proteins, as possible antimicrobial therapeutics. We discuss their structure, mechanism of action, and highlight examples of possible candidate molecules for clinical use. Finally, we discuss the remaining challenges and explore potential solutions for the implementation of therapeutic proteins into practical clinical use.

Salmonella and Salmonellosis: An Update on Public Health Implications and Control Strategies

Salmonellosis is globally recognized as one of the leading causes of acute human bacterial gastroenteritis resulting from the consumption of animal-derived products, particularly those derived from the poultry and pig industry. Salmonella spp. is generally associated with self-limiting gastrointestinal symptoms, lasting between 2 and 7 days, which can vary from mild to severe. The bacteria can also spread in the bloodstream, causing sepsis and requiring effective antimicrobial therapy; however, sepsis rarely occurs. Salmonellosis control strategies are based on two fundamental aspects: (a) the reduction of prevalence levels in animals by means of health, biosecurity, or food strategies and (b) protection against infection in humans. At the food chain level, the prevention of salmonellosis requires a comprehensive approach at farm, manufacturing, distribution, and consumer levels. Proper handling of food, avoiding cross-contamination, and thorough cooking can reduce the risk and ensure the safety of food. Efforts to reduce transmission of Salmonella by food and other routes must be implemented using a One Health approach. Therefore, in this review we provide an update on Salmonella, one of the main zoonotic pathogens, emphasizing its relationship with animal and public health. We carry out a review on different topics about Salmonella and salmonellosis, with a special emphasis on epidemiology and public health, microbial behavior along the food chain, predictive microbiology principles, antimicrobial resistance, and control strategies.

A comprehensive point prevalence survey of the quality and quantity of antimicrobial use in Chinese general hospitals and clinical specialties

Antimicrobial resistance (AMR) is a serious, worldwide public health crisis. Surveillance of antimicrobial use forms part of an essential strategy to contain AMR. We aimed to conduct a national point prevalence survey (PPS) on antimicrobial use, and to compare this data with similar international surveillance programs to provide a reference for future AMR strategy development in China. Twenty general hospitals encompassing 10,881 beds and 10,209 inpatients around the country participated the survey using a standardized protocol, at 8am of someday from October 10th to November 31st, 2019. Of the patients, 37.00% (3777/10209) received antimicrobial agents, 31.30% (1630/5208) had surgical operations, and 76.63% (1249/1630) received prophylactic antibiotic. The prevalence of antimicrobial use in medical, surgical, and intensive care units (ICU) patients was 38.84% (1712/4408), 32.07% (1670/5208), and 66.61% (395/593), respectively. Of prescriptions, 5.79% (356/6151) were made in the absence of indication. The intensity of antimicrobial use was 61.25 DDDs/100 patient days, while the intensity of use in internal medicine, surgery, and ICU were 67.79, 45.81, 124.45 DDDs/100 patient days, respectively. Only 11.62% (715/6151) of prescriptions had a reason described in the patient record. Furthermore, 8.44% (210/2487), 14.19% (424/2989), and 12% (81/675) of the prescriptions in internal medicine, surgery, and ICU had a recorded indication, respectively. The review and stop date recorded for antimicrobial therapy was 43.73% (1976/4518). Of the patients, 38.07% (1438/3777) received combination therapy. The classes of antimicrobials prescribed were limited, and the proportion of prescriptions encompassed by the top 20 antimicrobial agents was 75.06% (4617/6151). The prevalence of antimicrobial use in China is close to that of Sweden, the UK, and Canada, but lower than that in India, and higher than that in Switzerland. The data described in this report indicate that the quality of antimicrobial prescriptions requires improvement in China. Further, hospitals should implement professional interventions to improve the rational use of antimicrobials.

Stenotrophomonas maltophilia: An Urgent Threat with Increasing Antibiotic Resistance.

Stenotrophomonas maltophilia is a Gram-negative opportunistic pathogen that can cause many infections, such as chronic pulmonary infections in patients with cystic fibrosis and infections in immunocompromised patients with hematology-oncology diseases. Because of its remarkable and increasing antimicrobial resistance, the treatment of S. maltophilia infections is quite challenging. Meanwhile, the prevalence of S. maltophilia infections is increasing in recent decades. S. maltophilia is usually considered to be of low virulence but has numerous virulence factors involved in the pathogenesis of infections caused by S. maltophilia. By revealing its pathogenesis associated with virulence factors and molecular mechanisms of antimicrobial resistance, many existing or potential therapeutic strategies have been developed. However, because of the limited treatment options, new strategies are urgently needed. Here, we review the recent progresses in research on S. maltophilia which may help to develop more effective treatments against this increasing threat.

Understanding and Implementing Diagnostic Stewardship: A Guide for Resident Physicians in the Era of Antimicrobial Resistance.

Antimicrobial resistance (AMR) poses a significant global health challenge, exacerbated by the COVID-19 pandemic. Antimicrobial stewardship programs (ASPs) are crucial in managing this crisis, with diagnostic stewardship (DS) emerging as a key component. DS refers to the appropriate use of diagnostic tests to optimize patient outcomes, improve antimicrobial use, and combat multi-drug-resistant (MDR) organisms. Despite its potential, understanding and application of DS remain ambiguous in multiple respects, which, however, do not directly implicate the implementation of such initiatives. DS is particularly important for resident physicians who are often at the forefront of patient care and can significantly influence future AMR strategies. This review provides a comprehensive overview of DS, discussing its importance, potential challenges, and future directions. It emphasizes the need for resident physicians to understand DS principles and integrate them into their clinical practice from the beginning of their careers. The review also highlights the role of various stakeholders in implementing DS and the importance of continuous education and training. Ultimately, DS is not just a clinical tool but a philosophy of care, essential for a more responsive, humane, and effective healthcare system.

Impact of high-risk and low-risk population on COVID-19 dynamics considering antimicrobial resistance and control strategies

Impact of high-risk and low-risk population on COVID-19 dynamics considering antimicrobial resistance and control strategies

National action plans for antimicrobial resistance and variations in surveillance data platforms.

To assess how national antimicrobial susceptibility data used to inform national action plans vary across surveillance platforms. We identified available open-access, supranational, interactive surveillance platforms and cross-checked their data in accordance with the World Health Organization's (WHO's) Data Quality Assurance: module 1. We compared platform usability and completeness of time-matched data on the antimicrobial susceptibilities of four blood isolate species: Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pneumoniae from WHO's Global Antimicrobial Resistance and Use Surveillance System, European Centre for Disease Control's (ECDC's) network and Pfizer's Antimicrobial Testing Leadership and Surveillance database. Using Bland-Altman analysis, paired t-tests, and Wilcoxon signed-rank tests, we assessed susceptibility data and number of isolate concordances between platforms. Of 71 countries actively submitting data to WHO, 28 also submit to Pfizer's database; 19 to ECDC; and 16 to all three platforms. Limits of agreement between WHO's and Pfizer's platforms for organism-country susceptibility data ranged from -26% to 35%. While mean susceptibilities of WHO's and ECDC's platforms did not differ (bias: 0%, 95% confidence interval: -2 to 2), concordance between organism-country susceptibility was low (limits of agreement -18% to 18%). Significant differences exist in isolate numbers reported between WHO-Pfizer (mean of difference: 674, P-value: < 0.001, and WHO-ECDC (mean of difference: 192, P-value: 0.04) platforms. The considerable heterogeneity of nationally submitted data to commonly used antimicrobial resistance surveillance platforms compromises their validity, thus undermining local and global antimicrobial resistance strategies. Hence, we need to understand and address surveillance platform variability and its underlying mechanisms.

Antimicrobial Resistance (AMR) and Alternative Strategies for Combating AMR in Aquaculture

Antimicrobial resistance (AMR) in food production systems is regarded as a major threat to public health and nutrition security. Due to the potential for horizontal gene transfer, AMR in aquaculture might eventually spread to clinically important strains found in the environment, thereby affecting human health and the whole ecosystem. It is essential to comprehend the mechanisms driving AMR in aquaculture, including plasmids, integrons, and gene cassettes, to develop AMR risk management strategies. This review article presents an in-depth analysis of AMR in aquaculture and potential risks it presents to public health and the environment. The review provides a comprehensive understanding of the complexities of AMR by delving into the molecular and genetic factors that contribute to its spread. It also highlights the antibiotic usage pattern in different countries. The article also elaborates on alternative strategies that can be adopted to prevent and control fish diseases without negatively impacting the environment. This understanding may aid in the development of plans aimed at halting the spread of AMR and safeguarding public health. The various alternative approaches discussed in the review can offer potential solutions for controlling fish diseases in a manner that is both effective and environmentally safe for ecosystems and public health.

Quantifying the Economic and Clinical Value of Reducing Antimicrobial Resistance in Gram-negative Pathogens Causing Hospital-Acquired Infections in Australia.

Antimicrobial resistance (AMR) is a global public health challenge requiring a global response to which Australia has issued a National Antimicrobial Resistance Strategy. The necessity for continued-development of new effective antimicrobials is required to tackle this immediate health threat is clear, but current market conditions may undervalue antimicrobials. We aimed to estimate the health-economic benefits of reducing AMR levels for drug-resistant gram-negative pathogens in Australia, to inform health policy decision-making. A published and validated-dynamic health economic model was adapted to the Australian setting. Over a 10-year time horizon, the model estimates the clinical and economic outcomes associated with reducing current AMR levels, by up to 95%, of three gram-negative pathogens in three hospital-acquired infections, from the perspective of healthcare payers. A willingness-to-pay threshold of AUD$15,000-$45,000 per quality-adjusted life-year (QALY) gained and a 5% discount rate (for costs and benefits) were applied. Over ten years, reducing AMR for gram-negative pathogens in Australia is associated with up to 10,251 life-years and 8924 QALYs gained, 9041 bed-days saved and 6644 defined-daily doses of antibiotics avoided. The resulting savings are estimated to be $10.5 million in hospitalisation costs, and the monetary benefit at up to $412.1 million. Our results demonstrate the clinical and economic value of reducing AMR impact in Australia. Of note, since our analysis only considered a limited number of pathogens in the hospital setting only and for a limited number of infection types, the benefits of counteracting AMR are likely to extend well beyond the ones demonstrated here. These estimates demonstrate the consequences of failure to combat AMR in the Australian context. The benefits in mortality and health system costs justify consideration of innovative reimbursement schemes to encourage the development and commercialisation of new effective antimicrobials.