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The Economic Burden of Antibiotic Resistance: A Systematic Review and

Ak Narayan Poudel, Shihua Zhu, Nicola Cooper, Paul Little, Carolyn Tarrant, Matthew Hickman, Guiqing Yao.


Antibiotic resistance (ABR) has substantial global public health concerns. This systematic review aimed to synthesise recent evidence estimating the economic burden of ABR, characterised by study perspectives, healthcare settings, study design, and income of the countries.


Global health has improved significantly since the discovery of penicillin in 1928. However, organisms, such as bacteria have become increasingly resistant to many antibiotics in recent years. Although antibiotic resistance (ABR) is a natural phenomenon, the process of resistance is accelerated by overuse and misuse of antibiotics, and intercontinental travel. In the past, resistant infections were associated with hospitals and care settings, but over the last decades, these have been spread in the wider community.

Materials and Methods:

This review is in line with the ‘Preferred Reporting Items for Systematic Review and Meta-Analysis’ (PRISMA) checklist [30] and is registered to the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number- CRD42020193886. Ethical approval was not required for this study.


This review evidenced that a limited number of studies have been conducted on the economic burden of antibiotic resistance in recent years, as only 29 studies were identified published since January 2016 that included healthcare costs with suitable comparators (i.e., antibiotic resistant vs susceptible infections). Of these, a very limited number of studies were conducted in primary and secondary care settings. MRSA, E. coli and P. aeruginosa were the top three most studied resistant bacteria in recent economic burden studies.


We would like to thank all the members of the UK-China Partnership Hub for their direct or indirect support during preparation and finalisation of the paper.

Citation: Poudel AN, Zhu S, Cooper N, Little P, Tarrant C, Hickman M, et al. (2023) The economic burden of antibiotic resistance: A systematic review and meta-analysis. PLoS ONE 18(5): e0285170.

Editor: Iddya Karunasagar, Nitte University, INDIA

Received: February 15, 2023; Accepted: April 17, 2023; Published: May 8, 2023.

Copyright: © 2023 Poudel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting information files.

Funding: Funding details: 1. GY, NC, CT, MH and PL: MR/S013717/1 (Newton Fund: 2. GY, NC, CT, MH and PL: 13/34/64 (NIHR Health Technology Assessment Programme: 3. GY and PL: PB-PG-0416-20005 (NIHR Research for Patient Benefit: No. The funders had not role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: ABR, Antibiotics Resistance; AMR Review, Review on Antimicrobial Resistance; AMR, Antimicrobial Resistance; ART, antiretroviral therapy; CDC, Centre for Disease Control and Prevention; DHSC, Department of Health and Social Care (UK); HPA, Health Protection Agency; HPS, Health Protection Scotland; ICD, International Classification of Diseases; MDR, multi-drug resistance; NICE, National Institute for Health and Care Excellence; OHID, Office for Health Improvement and Disparities; PHE, Public Health Europe; PHS, Public Health Scotland; PHW, Public Health Wales; PICO, Population, Intervention, Comparison, Outcome; PLHIV, people living with HIV; PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analysis; UKSHA, UK Health Security Agency; WHO, World Health.

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