Quantifying uncertainty about future antimicrobial resistance: Comparing structured expert judgment and statistical forecasting methods

PLoS One. 2019 Jul 5;14(7):e0219190. doi: 10.1371/journal.pone.0219190. eCollection 2019.

Abstract

The increase of multidrug resistance and resistance to last-line antibiotics is a major global public health threat. Although surveillance programs provide useful current and historical information on the scale of the problem, the future emergence and spread of antibiotic resistance is uncertain, and quantifying this uncertainty is crucial for guiding decisions about investment in antibiotics and resistance control strategies. Mathematical and statistical models capable of projecting future rates are challenged by the paucity of data and the complexity of the emergence and spread of resistance, but experts have relevant knowledge. We use the Classical Model of structured expert judgment to elicit projections with uncertainty bounds of resistance rates through 2026 for nine pathogen-antibiotic pairs in four European countries and empirically validate the assessments against data on a set of calibration questions. The performance-weighted combination of experts in France, Spain, and the United Kingdom projected that resistance for five pairs on the World Health Organization's priority pathogens list (E. coli and K. pneumoniae resistant to third-generation cephalosporins and carbapenems and MRSA) would remain below 50% in 2026. In Italy, although upper bounds of 90% credible ranges exceed 50% resistance for some pairs, the medians suggest Italy will sustain or improve its current rates. We compare these expert projections to statistical forecasts based on historical data from the European Antimicrobial Resistance Surveillance Network (EARS-Net). Results from the statistical models differ from each other and from the judgmental forecasts in many cases. The judgmental forecasts include information from the experts about the impact of current and future shifts in infection control, antibiotic usage, and other factors that cannot be easily captured in statistical forecasts, demonstrating the potential of structured expert judgment as a tool for better understanding the uncertainty about future antibiotic resistance.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Bacteria / drug effects
  • Drug Resistance, Bacterial / drug effects*
  • Europe
  • Expert Testimony / methods*
  • Forecasting / methods*
  • France
  • Humans
  • Italy
  • Judgment
  • Microbial Sensitivity Tests
  • Models, Statistical
  • Spain
  • Uncertainty
  • United Kingdom

Substances

  • Anti-Bacterial Agents

Grants and funding

The research leading to these results has received support from the Innovative Medicines Initiative Joint Undertaking under grant agreement n°115618 [Driving re-investment in R&D and responsible antibiotic use, DRIVE-AB, www.drive-ab.eu], resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007-2013) and EFPIA companies’ in kind contribution. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.