Predicting sepsis mortality into an era of pandrug-resistant E. coli through modeling

Benjamin J Koch; Daniel E Park; Bruce A Hungate; Cindy M Liu; James R Johnson; Lance B Price

doi:10.1038/s43856-024-00693-7

Predicting sepsis mortality into an era of pandrug-resistant E. coli through modeling

Commun Med (Lond). 2024 Dec 26;4(1):278. doi: 10.1038/s43856-024-00693-7.

Authors

Benjamin J Koch^{1

2}, Daniel E Park³, Bruce A Hungate^{4

5}, Cindy M Liu³, James R Johnson^{6

7}, Lance B Price³

Affiliations

¹ Center for Ecosystem Science and Society, Northern Arizona University, Flagstaff, AZ, USA. [email protected].
² Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ, USA. [email protected].
³ Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
⁴ Center for Ecosystem Science and Society, Northern Arizona University, Flagstaff, AZ, USA.
⁵ Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ, USA.
⁶ Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.
⁷ University of Minnesota, Minneapolis, MN, USA.

Abstract

Background: Infections caused by antibiotic-resistant bacteria are increasingly frequent, burdening healthcare systems worldwide. As pathogens acquire resistance to all known antibiotics - i.e., become pan-resistant - treatment of the associated infections will become exceedingly difficult. We hypothesized that the emergence of pan-resistant bacterial pathogens will result in a sharp increase in human mortality.

Methods: We tested this hypothesis by modeling the impact of a single hypothetical pan-resistant Escherichia coli strain on sepsis deaths in the United States. We used long-term data on sepsis incidence, mortality rates, strain dynamics, and treatment outcomes to parameterize a set of models encompassing a range of plausible future scenarios. All models accounted for historical and projected temporal changes in population size and age distribution.

Results: The models suggest that sepsis deaths could increase 18- to 46-fold within 5 years of the emergence of a single pan-resistant E. coli strain. This large and rapid change contrasts sharply with the current expectation of gradual change under continuing multidrug-resistance.

Conclusions: Failure to prevent the emergence of pan-resistance would have dire consequences for public health.

Plain language summary

Antibiotic-resistant bacteria are an increasing risk to public health. As bacteria become resistant to all known antibiotics – i.e., become pan-resistant – treatment of infections will become extremely difficult. We hypothesized that the appearance of pan-resistant bacteria will result in a sharp increase in mortality. We tested this hypothesis using computer and mathematical modeling to see how a single hypothetical pan-resistant type of bacteria would impact deaths in the United States. Drawing from existing long-term data, deaths from infection in the general population could increase dramatically within 5 years of the emergence of a single pan-resistant type of common bacteria. Failing to prevent the emergence of pan-resistance would have dire consequences for public health.

Abstract

Plain language summary

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