Background:
     
     Quantifying the resource use and cost of antimicrobial resistance establishes the magnitude of the problem and drives action.
   

Objectives:
     
     Assessment of resource use and cost associated with infections with six key drug-resistant pathogens in Europe.
   

Methods:
     
     A systematic review and Bayesian meta-analysis.
   

Data sources:
     
     MEDLINE (Ovid), Embase (Ovid), Econlit databases, and grey literature for the period 1 January 1990, to 21 June 2022.
   

Study eligibility criteria:
     
     Resource use and cost outcomes (including excess length of stay, overall costs, and other excess in or outpatient costs) were compared between patients with defined antibiotic-resistant infections caused by carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, CR or third-generation cephalosporin Escherichia coli (3GCREC) and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus faecium, and patients with drug-susceptible or no infection.
   

Participants:
     
     All patients diagnosed with drug-resistant bloodstream infections (BSIs).
   

Interventions:
     
     NA.
   

Assessment of risk of bias:
     
     An adapted version of the Joanna Briggs Institute assessment tool, incorporating case-control, cohort, and economic assessment frameworks.
   

Methods of data synthesis:
     
     Hierarchical Bayesian meta-analyses were used to assess pathogen-specific resource use estimates.
   

Results:
     
     Of 5969 screened publications, 37 were included in the review. Data were sparse and heterogeneous. Most studies estimated the attributable burden by, comparing resistant and susceptible pathogens (32/37). Four studies analysed the excess cost of hospitalization attributable to 3GCREC BSIs, ranging from -€ 2465.50 to € 6402.81. Eight studies presented adjusted excess length of hospital stay estimates for methicillin-resistant S. aureus and 3GCREC BSIs (4 each) allowing for Bayesian hierarchical analysis, estimating means of 1.26 (95% credible interval [CrI], -0.72 to 4.17) and 1.78 (95% CrI, -0.02 to 3.38) days, respectively.
   

Conclusions:
     
     Evidence on most cost and resource use outcomes and across most pathogen-resistance combinations was severely lacking. Given the importance of this evidence for rational policymaking, further research is urgently needed.