The MARIA Study: Multimorbidity, Antimicrobial Resistance and Infection Associations (360G-Wellcome-341873_Z_25_Z)

Background: Multimorbidity is associated with premature death, increased likelihood of hospitalisation, and poor quality of life. The COVID-19 pandemic showed a close relationship between infection, morbidity and poor patient outcomes, and as a result those most at-risk of deterioration were prioritised for shielding, vaccination and treatment. However, the relationship between multimorbidity, bacterial infection and antimicrobial resistance (AMR) is poorly understood. Aim: To undertake foundational work investigating the relationship between multimorbidity, bacterial infection and AMR to inform strategies to improve patient outcomes and care. Approach: We will synthesise existing evidence on the epidemiology and burden of infection in multimorbidity through a systematic literature review (SLR) and meta-analysis. Using linked NHS datasets, we will undertake a retrospective cohort study to investigate whether bacterial infection leads to worse patient outcomes and more AMR in patients with multimorbidity, and to test whether acute bacterial infection is an indication of deterioration in multimorbidity. Genomic sequencing will be applied to characterise resistant infections and infer how they are transmitted. Expected outputs: Using the results from our SLR and cohort study we will develop a clinical risk stratification tool to identify patients at greatest risk of deterioration.