Priority assessment of antimicrobial-resistant pathogens in the Republic of Korea: a multicriteria decision analysis

초록

Background Priority assessment of antimicrobial-resistant pathogens is essential for resource allocation and national risk management. This study aims to establish a priority list of antimicrobial-resistant pathogens to strengthen the national response to antimicrobial resistance (AMR) in the Republic of Korea (ROK). Methods Antimicrobial-resistant pathogens were ranked throughout a multicriteria decision analysis using a preference-based survey based on PAPRIKA (Potentially All Pairwise Rankings of all possible Alternatives) method. This process involved identifying relevant criteria to evaluate pathogen priority and collecting data on disease burden for each antimicrobial-resistant pathogen. Findings A literature review was conducted to develop a candidate list of antimicrobial-resistant pathogens (n = 56) and risk assessment criteria (n = 14). Seventeen pathogens and eight criteria were selected via a Delphi survey of experts (n = 31). Incidence, case fatality, five-year trend of AMR, and nonfatal health burden was set as quantitative indicators, while transmissibility, preventability, treatability, and antibiotic development pipeline were qualitative indicators. The pathogens were ranked using 56 expert responses from the PAPRIKA survey, and categorized them into three priority groups: emergency response, preferred management, and monitoring. The emergency response group included carbapenem-resistant (CR) Klebsiella pneumoniae, CR Acinetobacter baumannii, and vancomycin-resistant Enterococcus faecium. Interpretation This priority list represents the first comprehensive assessment of AMR pathogens of greatest concern to the Korean healthcare system. Our findings may inform country-specific policy decisions, particularly regarding infection prevention and control and AMR research and development.