Edward Broughton: Hello, everyone. Today, I'm discussing our recent systematic literature review examining the global epidemiology and burden of complicated urinary tract infections or cUTIs, and why these findings underscore the urgent need to rethink how we evaluate the economic impact of antimicrobial resistance and ultimately how we value novel antibiotics. Urinary tract infections are among the most common bacterial infections worldwide. Many uncomplicated cases resolve with or without treatment. But complicated UTIs, including acute pyelonephritis and catheter-associated UTIs, are a different story. These infections are harder to treat and associated with significantly higher morbidity and mortality. In our systematic review, covering a decade of real-world evidence across Europe, Asia, and the United States, we screened more than a thousand articles and identified 118 relevant studies. One thing became clear early on: disease presentation and outcomes vary widely, and major gaps in global epidemiologic data persist. Here are three important takeaways from the review.

First, most available incidence and prevalence data came from the United States. Strikingly, no studies reported that these foundational metrics were identified in China, Germany, or the United Kingdom, countries with large, complex health systems. This means that we're still operating without a complete picture of the global picture of burden of disease. Second, antimicrobial resistance was consistently high across inpatient and outpatient populations. This directly compromises the effectiveness of standard therapies and contributes to clinical deterioration, prolonged hospital stays, and increased healthcare utilization. Third, mortality in hospital patients ranged anywhere from zero to 50%, depending on the population. That variability reflects the clinical complexity and the underlying challenges posed by resistant pathogens. Taken together, these findings demonstrate that cUTIs impose a substantial burden on patients and healthcare systems, but they also highlight how incomplete our understanding is, especially when resistance limits treatment options. And that brings us to why it matters for health economics and antimicrobial innovation.

The economic burden of antimicrobial resistant infections, whether in the urinary tract or other sites, extends far beyond the direct cost of treatment. Resistant infections drive longer hospitalizations, additional diagnostics, greater use of second and third line antibiotics, and downstream complications. They also spread among the population, creating a heavy burden on the healthcare system. Yet these indirect and system level costs are often underestimated or not even accounted for. Without robust data capturing the true clinical and economic consequences of AMR, we risk undervaluing the impact of effective antimicrobials. Traditional cost-effectiveness models rarely incorporate the broader societal values of antibiotics in the context of antimicrobial resistance, such as preventing outbreaks, preserving healthcare capacity, or enabling high-risk procedures such as transplants, oncology treatments, and major surgeries.

To sustain the antibiotic pipeline, we need a more comprehensive framework that reflects the full value of these therapies. This is why we have several peer-reviewed publications based on the steady model that accounts for the spectrum of a novel antimicrobial, the public health impact of transmission of the disease, enablement of other medical interventions when an effective antimicrobial is available, the benefits of a diverse range of antimicrobials, and the public health insurance value of handing antimicrobials that actually work. We need better epidemiology, better measures of AMR related costs, and value assessment that recognize the antibiotics as critical infrastructure for the modern health system. In short, this SLR underscores both the heavy burden of complicated UTIs and the substantial knowledge gaps that remain. To reduce mortality, curve resistance, and ensure a steady supply of effective treatments, we must strengthen clinical trial and real world evidence generation and rethink how we evaluate the economic and societal value of new antibiotics. Thank you for watching.