Development of the antimicrobial resistance burden score through a modified eDelphi

Current antimicrobial resistance (AMR) surveillance relies on fragmented indicators that fail to capture institutional AMR burden complexity. To develop the AMR Burden Score, a three-round modified eDelphi study engaged interdisciplinary experts (Round 1: n = 17, Rounds 2 and 3: n = 7), including clinicians, microbiologists, pharmacists, health economists, and public health specialists. The AMR Burden Score comprises six weighted domains: Resistance (25%), Effectiveness (30%), Monitoring (30%), Adoption (5%), Processes (5%), and Systems (5%). Strong consensus emerged for core indicators, including incidence of resistant infections (unanimous Round 3 agreement, median 8.0), pathogen-specific resistance rates (median 7.0), and staff training programmes (median 8.0). The AMR Burden Score provides a structured framework for institutional AMR assessment, though implementation requires context-specific adaptation and further validation.