Antimicrobial Resistance Trends, Predictors, and Burden in England: a retrospective study using the Clinical Practice Research Datalink from 2015 to 2021

Amer Taie; Maria Gheorghe; James Amos; Alec Morton; Jason Gordon; Nia C Jenkins; Thomas E Padgett; Joe Hollinghurst; Gemma Taylor

doi:10.1016/j.ijantimicag.2025.107535

Antimicrobial Resistance Trends, Predictors, and Burden in England: a retrospective study using the Clinical Practice Research Datalink from 2015 to 2021

Amer Taie, Maria Gheorghe, James Amos, Alec Morton, Jason Gordon, Nia C Jenkins, Thomas E Padgett, Joe Hollinghurst, Gemma Taylor

Department of Psychology

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: Evidence describing the burden of antimicrobial resistance (AMR) to health care systems is essential to inform health care policy to tackle AMR. This study aims to investigate trends, predictors, and clinical and economic burden of AMR within the English National Health Service.

Methods: We conducted a 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 International Classification of Diseases, 10th revision, 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 with those without was created. Incidence rate ratios were estimated between those 2 groups for hospital length of stay (from admission to discharge), rehospitalisations within 1 year of diagnosis of infection, and total hospital costs. Acceleration factors were estimated for time to all-cause mortality and first rehospitalisation.

Results: 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 £3441 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 rehospitalised, respectively. Acceleration factors indicated patients with AMR infections die 27% earlier and rehospitalised 26% earlier than those with non-AMR infections.

Conclusion: AMR is a significant and growing threat to health care; this analysis suggests that AMR is associated with significant excess of health care use and increased mortality and readmission.

Original language	English
Article number	107535
Journal	International Journal of Antimicrobial Agents
Volume	66
Issue number	3
Early online date	13 May 2025
DOIs	https://doi.org/10.1016/j.ijantimicag.2025.107535
Publication status	Published - 30 Sept 2025

Acknowledgements

The authors thank Dr Gwen Knight for providing their invaluable contribution to interpreting the research analysis. The authors also thank James Dennis and Rowena Jenkins of Health Economics and Outcomes Research Ltd. for providing medical writing support/editorial support in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Funding

This work was supported by Pfizer, who provided support for the analysis and medical writing for this study. Competing Interests: Amer Taie and Maria Gheorghe are employees of Pfizer Inc. Jason Gordon, Joe Hollinghurst, Gemma Taylor and Nia Jenkins are employees of Health Economics and Outcomes Research Ltd. Health Economics and Outcomes Research Ltd. received fees from Pfizer Inc. in relation to this study.

Funders	Funder number
Pfizer

Keywords

Antimicrobial resistance
Disease burden
Epidemiology
Public health
Retrospective cohort study

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases
Pharmacology (medical)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Taie, A., Gheorghe, M., Amos, J., Morton, A., Gordon, J., Jenkins, N. C., Padgett, T. E., Hollinghurst, J., & Taylor, G. (2025). Antimicrobial Resistance Trends, Predictors, and Burden in England: a retrospective study using the Clinical Practice Research Datalink from 2015 to 2021. International Journal of Antimicrobial Agents, 66(3), Article 107535. https://doi.org/10.1016/j.ijantimicag.2025.107535

Taie, A, Gheorghe, M, Amos, J, Morton, A, Gordon, J, Jenkins, NC, Padgett, TE, Hollinghurst, J & Taylor, G 2025, 'Antimicrobial Resistance Trends, Predictors, and Burden in England: a retrospective study using the Clinical Practice Research Datalink from 2015 to 2021', International Journal of Antimicrobial Agents, vol. 66, no. 3, 107535. https://doi.org/10.1016/j.ijantimicag.2025.107535

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abstract = "Objectives: Evidence describing the burden of antimicrobial resistance (AMR) to health care systems is essential to inform health care policy to tackle AMR. This study aims to investigate trends, predictors, and clinical and economic burden of AMR within the English National Health Service. Methods: We conducted a 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 International Classification of Diseases, 10th revision, 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 with those without was created. Incidence rate ratios were estimated between those 2 groups for hospital length of stay (from admission to discharge), rehospitalisations within 1 year of diagnosis of infection, and total hospital costs. Acceleration factors were estimated for time to all-cause mortality and first rehospitalisation. Results: 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 £3441 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 rehospitalised, respectively. Acceleration factors indicated patients with AMR infections die 27\% earlier and rehospitalised 26\% earlier than those with non-AMR infections. Conclusion: AMR is a significant and growing threat to health care; this analysis suggests that AMR is associated with significant excess of health care use and increased mortality and readmission.",

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AU - Hollinghurst, Joe

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Antimicrobial Resistance Trends, Predictors, and Burden in England: a retrospective study using the Clinical Practice Research Datalink from 2015 to 2021

Abstract

Acknowledgements

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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