Determining the global burden of antimicrobial resistance – The GRAM project

Background: The Global Research on AntiMicrobial resistance (GRAM) project is a partnership between the University of Oxford and the Institute of Health Metrics and Evaluation (IHME) in Seattle. The project aims to provide robust, comprehensive and timely evidence of the global burden of drug resistant infections (DRI)/antimicrobial resistance (AMR) in 195 countries and territories. The work focusses on 17 bacteria-antibacterial drug (“bug-drug”) combinations (Salmonella enterica serovar Typhi and Paratyphi A, Non-Typhoidal Salmonella, Shigella species, Mycobacterium tuberculosis, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae and Neisseria gonorrhoeae), we aim to: i) consolidate, review and analyse all available data and scientific information on DRI/AMR worldwide (1990 onwards) to generate comparable AMR burden estimates for all clinical syndromes and bug-drug combinations; ii) produce granular geospatial maps of AMR burden as detailed as the data will allow; and iii) promote the widespread dissemination of results using tools and interactive data visualizations. Methods and materials: The work focusses on 17 bacteria-antibacterial drug (“bug-drug”) combinations (Salmonella enterica serovar Typhi and Paratyphi A, Non-Typhoidal Salmonella, Shigella species, Mycobacterium tuberculosis, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae and Neisseria gonorrhoeae), we aim to: i) consolidate, review and analyse all available data and scientific information on DRI/AMR worldwide (1990 onwards) to generate comparable AMR burden estimates for all clinical syndromes and bug-drug combinations; ii) produce granular geospatial maps of AMR burden as detailed as the data will allow; and iii) promote the widespread dissemination of results using tools and interactive data visualizations. Results: Our geospatial mapping shows the change in resistance over time for Salmonella enterica serovar Typhi and Paratyphi A for MDR and Fluoroquinolone resistance. Preliminary estimates for excess mortality due to AMR are being performed and will be discussed. Conclusion: This work will generate comparable AMR burden estimates across all 195 countries together with geospatial maps with the granularity dependent upon the data available, and ensure drug resistant infections.