1803. Analysis of National Policies and Antimicrobial Resistance Burden: An Ecological Study of 114 Countries

BACKGROUND: The rise of antimicrobial resistance (AMR) is a top public health concern. The drivers of AMR are complex, with antimicrobial misuse, lack of coordinated policies and inter-country data cooperation playing key roles. The growing burden of AMR is not shared proportionally across countries and there’s marked heterogeneity of national-level policies to tackle AMR. Our aim was to evaluate whether stronger national policies correlate with reduced burden 3rd generation cephalosporin (3GC) resistant Escherichia coli utilizing two recently published estimates. METHODS: We used 2019 estimates of deaths and Disability Adjusted Life Years (DALYs) due to 3GC resistant E. coli published by Murray et al. We matched these estimates to the governance score produced by Patel et al, which analyzed National Action Plans (NAP) through a governance framework, assigning a “governance score” to countries based on 54 indicators across 3 domains (Table 1). We describe the relationship between the burden of 3GC resistant E. coli and governance score across six WHO regions: Africa, Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific. [Figure: see text] RESULTS: A total of 114 countries with both governance score and 3GC resistant E. coli data available were included. A multivariate log-linear regression model adjusted for region showed a relative risk reduction in the mortality of 3GC resistant E. coli of 2.8% (CI 1% –4.6%; p-value 0.002) for every increase in point of governance score (Figure 1). When looking at DALYs as a measure of AMR burden, using a multivariate log-linear regression model adjusted for regions, we find a relative risk reduction of 4.7% (CI 1.8% - 6.2%; P value < 0.001) for every increase in point of governance score (Figure 2). [Figure: see text] [Figure: see text] CONCLUSION: We show that countries with high governance scores had overall lower burden of 3GC resistant E. coli. Additional time series analysis as well as evaluating specific aspects of NAPs against AMR burden would be an important next step. DISCLOSURES: All Authors: No reported disclosures