Study Examines Clinical and Economic Impact of Antimicrobial Resistance at Acute Care Facilities

​​By: BD - Canada

Researchers at Sinai Health System, University Health Network and Becton, Dickinson and Company (BD) have developed an economic model for evaluating the clinical and economic impact of antimicrobial resistance (AMR).1

Estimating the clinical and economic impact of AMR is critical to building a case for the development of antimicrobial stewardship programs in Canada's health care facilities. With the help of this tool, we can illustrate the importance of infection prevention, stewardship, surveillance, and the health care professionals who manage these programs.

The tool can be used to evaluate the clinical and economic impact for the top five resistant organisms in the acute care setting: Klebsiella pneumonia, Escherichia coli, Enterococcus faecium, Pseudomonas aeruginosa and Staphylococcus aureus. The model used data from literature and a hospital in Ontario, including annual direct and indirect costs. The main limitation of the study was the lack of published data describing the incremental costs of resistant infections compared to susceptible infections.1

The study estimated that these top five infections could cost $9.9 million to manage at an acute care centre with about 400 beds.

Of that, the cost of the resistant infections was $2.1 million, and the incremental cost of resistance (i.e. the additional cost to manage these patients because of resistance) was $1.1 million. The number of deaths from the top five infections in the acute care setting amounted to 149 annually. Of those, 104 were from susceptible infections and 45 due to resistant infections. Extrapolating to 100% resistance, the burden could rise to as much as $30 million and nearly 700 deaths. With increasing resistance, the growing cost of managing infections would be attributable to AMR.

By 2050, global estimates suggest antimicrobial resistance (AMR) could cause 10 million deaths annually and cost up to $100 trillion to the world economy.2 Health care facilities have been encouraged to make a business case for funding Antimicrobial Stewardship Programs3, however, data demonstrating AMR's clinical and economic impact has not been well captured and analyzed.

"Tackling antimicrobial resistance needs governments and other players to be 'all in', and you can't be 'all in' unless you recognize the economic implications of AMR," says Dr. Andrew Morris, MD, SM(Epi), FRCPC, Medical Director, Antimicrobial Stewardship Program, Sinai Health System/University Health Network. 

While providing a practical resource for assessing the impact of AMR, the tool also illustrates gaps in data availability. One of the main goals in the development of this tool is to initiate partnerships for generating evidence and customizing inputs for other facilities and regions.

Access the Tool

The open-access tool developed in this study will be available to health care facilities in 2020 at and Members of the health care community are invited to learn more about estimating the clinical and economic burden of AMR within their acute care settings once the tool is available for use.


  1. Chelsea Smallwood, M.Sc., et al. Examining the clinical and economic impact of antimicrobial resistance at acute care facilities: a practical tool. 2019
  2. O'Neill J. Tackling drug-resistant infections globally: Final report and recommendations. Creative Commons Attribution 4.0 International Public Licence, 2016.  
  3. Ronald Small, Whitehurst S. Developing a Business Case for an Antimicrobial Stewardship Program. Joint Commission Resources, 2012.