Low- and middle-income countries (LMICs) are expected to bear the greatest health and economic consequences of antimicrobial resistance (AMR). The UK AMR Review estimated that by 2050, up to 90% of all deaths related to AMR will be from Africa and Asia.

The BALANCE study compares the deaths caused by multi-drug-resistant infections in LMICs  with that of high-income countries. 

What is the BALANCE study?

The BALANCE study is named for its aim of enhancing and supporting the scientific capacity of hospitals in LMICs to capture high-quality clinical and laboratory data. High quality, consistent data can then be collected from countries where this has not been possible in the past. 

This will allow researchers to compare the infection and death rates caused by multi-drug resistant bacteria in LMICs and high-income countries. 

The BALANCE motto is ‘Prevent Sepsis and Save Antibiotics’. 

BALANCE collaborators in Oxford


We are working with clinicians and laboratory professionals in tertiary care hospitals across 8 countries (Bangladesh, Kenya, Nigeria, Pakistan, Sierra Leone, Turkey, Italy, and Poland) to collect information about patients with bloodstream infections, including: 

  • Laboratory data – information about infections, including their resistance to antibiotics. 
  • Demographic data- how does the age or sex of patients relate to their health outcomes? 
  • Socioeconomic data- how does this affect treatment and therefore clinical outcomes?   
  • Clinical data- do patients have any other health conditions affecting their outcomes?

As well as collecting this wide range of data about patients, we also collect information about the hospitals, including their infection prevention and control, and antibiotic stewardship status and investigate how these relate to AMR-attributable deaths.

To ensure that our data is as robust as possible, we will compare the outcomes of patients with antibiotic-resistant infections to those with antibiotic-susceptible infections, and without infections, in different hospital sites. Bacterial factors will be examined through robust microbiology and comprehensive genomic analysis by researchers in Oxford. As part of investigating economic burden, we will evaluate how patients’ inability to pay for antibiotics or laboratory investigations impact deaths caused by AMR.

The dataset BALANCE produces will provide evidence for recommendations to reduce the burden of antibiotic-resistant infections. Data will be given to hospitals regularly to develop targeted interventions.