Systematic Literature Review on the Clinical and Economic Burdens of Antimicrobial Resistance in the Japanese Population

OBJECTIVES: Comprehensive evidence of clinical and economic burdens in antimicrobial resistance (AMR) in Japan is limited. The aim of this study is to summarize existing research studies related to AMR-caused disease burden.

METHODS: This review was conducted in accordance with PRISMA guidelines. Studies published during 2012–2022 describing the Japanese adult population were included. The MEDLINE, Embase, Cochrane Library, and ICHUSHI databases were searched based on the inclusion/exclusion criteria. Outcomes were in-hospital death, hospitalization period, and direct medical costs. Studies with comparable control groups were assessed for differences in these outcomes.

RESULTS: 56 observational studies (35 English, 21 Japanese) were included. 53 (94.6%) were cohort studies. Among all pathogens, MRSA was the most common (29 studies [51.8%]), followed by carbapenem-resistant bacteria (7 studies [12.5%]) and multiple resistant bacteria (7 studies [12.5%]). Among infections, bloodstream infections were the most common (14 studies [25.0%]), followed by pneumonia (9 studies [16.1%]), and surgical site infections (4 studies [7.1%]). 22 studies (39.3%) reported outcomes in the AMR and non-AMR groups, with in-hospital mortality rates of 10.5%–73.3% and 5.5%–45.0%, respectively. The median direct medical costs for the AMR and non-AMR groups ranged from USD 6,681 to USD 22,263 and from USD 3,870 to USD 18,263, respectively, with the AMR group being higher.

CONCLUSIONS: This study summarized the current evidence on AMR-caused disease burden in Japan. Because information is limited, further evidence generation is necessary for a better understanding of the disease burden effect of AMR in Japan.