Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis - 21/12/18

Doi : 10.1016/S1473-3099(18)30605-4

Alessandro Cassini, MD ^a,^b,⁎ , Liselotte Diaz Högberg, PhD ^a, Diamantis Plachouras, PhD ^a, Annalisa Quattrocchi, PhD ^a, Ana Hoxha, MSc ^a, Gunnar Skov Simonsen, PhD ^c,^d, Mélanie Colomb-Cotinat, PhD ^e, Mirjam E Kretzschmar, PhD ^b,^f, Brecht Devleesschauwer, PhD ^g,^h, Michele Cecchini, PhD ⁱ, Driss Ait Ouakrim, PhD ⁱ, Tiago Cravo Oliveira, PhD ⁱ, Marc J Struelens, PhD ^a, Carl Suetens, MD ^a, Dominique L Monnet, PhD ^a
the
Burden of AMR Collaborative Group ^{^†}
Members listed at the end of the Article

Reinhild Strauss, Karl Mertens, Thomas Struyf, Boudewijn Catry, Katrien Latour, Ivan N Ivanov, Elina G Dobreva, Arjana Tambic Andraševic, Silvija Soprek, Ana Budimir, Niki Paphitou, Helena Žemlicková, Stefan Schytte Olsen, Ute Wolff Sönksen, Pille Märtin, Marina Ivanova, Outi Lyytikäinen, Jari Jalava, Bruno Coignard, Tim Eckmanns, Muna Abu Sin, Sebastian Haller, George L Daikos, Achilleas Gikas, Sotirios Tsiodras, Flora Kontopidou, Ákos Tóth, Ágnes Hajdu, Olafur Gudlaugsson, Karl G Kristinsson, Stephen Murchan, Karen Burns, Patrizio Pezzotti, Carlo Gagliotti, Uga Dumpis, Agne Liuimiene, Monique Perrin, Michael A Borg, Sabine C de Greeff, Jos CM Monen, Mayke BG Koek, Petter Elstrøm, Dorota Zabicka, Aleksander Deptula, Waleria Hryniewicz, Manuela Caniça, Paulo Jorge Nogueira, Paulo André Fernandes, Vera Manageiro, Gabriel A Popescu, Roxana I Serban, Eva Schréterová, Slavka Litvová, Mária Štefkovicová, Jana Kolman, Irena Klavs, Aleš Korošec, Belén Aracil, Angel Asensio, María Pérez-Vázquez, Hanna Billström, Sofie Larsson, Jacqui S Reilly, Alan Johnson, Susan Hopkins

^a European Centre for Disease Prevention and Control, Solna, Sweden

^b Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands

^c University Hospital of North Norway, Tromsø, Norway

^d Research Group for Host-Microbe Interaction, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway

^e Santé publique France, Saint-Maurice, France

^f Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands

^g Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium

^h Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium

ⁱ Organisation for Economic Co-operation and Development, Paris, France

^* Correspondence to: Dr Alessandro Cassini, European Centre for Disease Prevention and Control, Solna 16973, Sweden European Centre for Disease Prevention and Control Solna 16973 Sweden

Summary

Background

Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs).

Methods

We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature.

Findings

From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece.

Interpretation

Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases.

Funding

European Centre for Disease Prevention and Control.

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Plan

Introduction

Methods

Overview

Study design and population

Disease models and attributable mortality

Estimation of incidence

Computational analysis and uncertainty

Attribution to health care and analysis of MRSA

Role of the funding source

Results

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Vol 19 - N° 1

P. 56-66 - janvier 2019 Retour au numéro

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Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis - 21/12/18

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