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1. Monitoring Antimicrobial Resistance and Drug Usage in the Human and Livestock Sector and Foodborne Antimicrobial Resistance in Six European Countries

Author

Mesa Varona O, Chaintarli K, Muller-Pebody B, Anjum MF, Eckmanns T, Norström M, Boone I, and Tenhagen BA

Subjects
amr, amu, food-producing animals, harmonization, monitoring, surveillance, Infectious and parasitic diseases, RC109-216
Abstract

Octavio Mesa Varona,1 Katerina Chaintarli,2 Berit Muller-Pebody,3 Muna F Anjum,2 Tim Eckmanns,4 Madelaine Norström,5 Ides Boone,4 Bernd-Alois Tenhagen1 1Department of Biological Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany; 2Department of Bacteriology, Animal and Plant Health Agency (APHA), Addlestone, Surrey, UK; 3Healthcare-Associated Infections & Antimicrobial Resistance Division, National Infection Service, Public Health England (PHE), London, UK; 4Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany; 5Department of Analysis and Diagnostics, Section of Epidemiology, Norwegian Veterinary Institute (NVI), Oslo, NorwayCorrespondence: Octavio Mesa Varona Diedersdorfer Weg 1, Berlin 12277, GermanyTel +49 30 1841224338Email Octavio.Mesa-Varona@bfr.bund.deIntroduction: Antimicrobial resistance (AMR), associated with antimicrobial use (AMU), is a major public concern. Surveillance and monitoring systems are essential to assess and control the trends in AMU and AMR. However, differences in the surveillance and monitoring systems between countries and sectors make comparisons challenging. The purpose of this article is to describe all surveillance and monitoring systems for AMU and AMR in the human and livestock sectors, as well as national surveillance and monitoring systems for AMR in food, in six European countries (Spain, Germany, France, the Netherlands, the United Kingdom and Norway) as a baseline for developing suggestions to overcome current limitations in comparing AMU and AMR data.Methods: A literature search in 2018 was performed to identify relevant peer-reviewed articles and national and European grey reports as well as AMU/AMR databases.Results: Comparison of AMU and AMR systems across the six countries showed a lack of standardization and harmonization with different AMU data sources (prescription vs sales data) and units of AMU and AMR being used. The AMR data varied by sample type (clinical/non-clinical), laboratory method (disk diffusion, microdilution, and VITEK, among others), data type, ie quantitative (minimum inhibition concentration (MIC) in mg/L/inhibition zone (IZ) in mm) vs qualitative data (susceptible-intermediate-resistant (SIR)), the standards used (EUCAST/CLSI among others), and/or the evaluation criteria adopted (epidemiological or clinical).Discussion: A One Health approach for AMU and AMR requires harmonization in various aspects between human, animal and food systems at national and international levels. Additionally, some overlap between systems of AMU and AMR has been encountered. Efforts should be made to improve standardization and harmonization and allow more meaningful analyses of AMR and AMU surveillance data under a One Health approach.Keywords: AMR, AMU, food-producing animals, harmonization, monitoring, surveillance

Published
2020

7. The Percentage of Antibiotic Resistance in Uncomplicated Community-Acquired Urinary Tract Infections: Findings of the RedAres Project.

Author

Klingeberg, A., Willrich, N., Schneider, M., Schmiemann, G., Ggyor, I., Richter, D., Noll, I., and Eckmanns, T.

Abstract

Background: Uncomplicated bacterial urinary tract infections (uUTIs) are commonly seen in outpatient practice. They are usually treated empirically with antibiotics. The pertinent German Clinical Practice Guideline contains recommendations on antibiotic selection, with the additional advice that the local resistance situation should be considered as well. However, up-to-date information on local resistance is often unavailable, because microbiological testing is mainly recommended for complicated UTIs. Resistance rates are often higher in recurrent uUTIs than in single episodes. In this study, we aimed to determine the resistance rates of Escherichia coli (E. coli) in patients with community-acquired uUTIs and to make these data available to the treating physicians. Methods: In a nationwide cross-sectional study in Germany (DRKS 00019059), we determined the percentages of resistance to antibiotics recommended for uUTIs (first choice: fosfomycin, nitroxoline, mecillinam, nitrofurantoin, trimethoprim; second choice: cefpodoxime, ciprofloxacin, cotrimoxazole, levofloxacin, norfloxacin, ofloxacin) over the period 2019-2021. The data were stratified by single episodes vs. recurrent UTIs (rUTIs). Results: Data from 2390 subjects were analyzed. E. coli was found in 75.4% of the samples with positive urine cultures (1082 out of 1435). The resistance rate of E. coli in single episodes (n = 725) was less than 15% for all antibiotics tested. In rUTIs (n = 357), resistance rates were also less than 15% for the most part; the only exceptions were trimethoprim (21.4%) and cotrimoxazole (19.3%). Conclusion: For single episodes of uUTI, all of the antibiotics studied can be recommended, at least as far as their resistance profiles are concerned. For recurrent UTI, all but trimethoprim and cotrimoxazole can be recommended. The second-choice antibiotics examined do not have a more favorable resistance profile than the first-choice antibiotics. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Finale Ergebnisse: REDARES - Reduktion von Antibiotikaresistenzen durch leitliniengerechte Behandlung von Patientinnen mit unkompliziertem Harnwegsinfekt in der ambulanten Versorgung - eine randomisiert kontrollierte Studie

Author

Greser, A, Schmiemann, G, Heuschmann, P, Miljukov, O, Heintze, C, Schuster, A, Bleidorn, J, Eckmanns, T, Maun, A, Gágyor, I, Greser, A, Schmiemann, G, Heuschmann, P, Miljukov, O, Heintze, C, Schuster, A, Bleidorn, J, Eckmanns, T, Maun, A, and Gágyor, I

Published
2023

12. Erste Ergebnisse: RedAres – Reduktion von Antibiotikaresistenzen durch leitliniengerechte Behandlung von Patientinnen mit unkompliziertem Harnwegsinfekt in der ambulanten Versorgung – eine randomisiert kontrollierte Studie

Author

Greser, A, Schmiemann, G, Heuschmann, PU, Miljukov, O, Heintze, C, Schuster, A, Maun, A, Minin, V, Bleidorn, J, Böhme, M, Eckmanns, T, Klingeberg, A, and Gágyor, I

Subjects
ddc: 610, Medicine and health
Abstract

Hintergrund: In der S3-Leitlinie zur Versorgung von Patient:innen mit einer Harnwegsinfektion wird auf den Einsatz von Zweitwahlantibiotika erst nach Versagen von Erstwahlantibiotika hingewiesen. Die Verordnungsraten für Zweitwahlantibiotika in Deutschland liegen bei bis zu 50% und damit deutlich [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Published
2022
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16. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis

Author

Murray, CJL, Ikuta, KS, Sharara, F, Swetschinski, L, Aguilar, GR, Gray, A, Han, C, Bisignano, C, Rao, P, Wool, E, Johnson, SC, Browne, AJ, Chipeta, MG, Fell, F, Hackett, S, Haines-Woodhouse, G, Hamadani, BHK, Kumaran, EAP, McManigal, B, Agarwal, R, Akech, S, Albertson, S, Amuasi, J, Andrews, J, Aravkin, A, Ashley, E, Bailey, F, Baker, S, Basnyat, B, Bekker, A, Bender, R, Bethou, A, Bielicki, J, Boonkasidecha, S, Bukosia, J, Carvalheiro, C, Castaneda-Orjuela, C, Chansamouth, V, Chaurasia, S, Chiurchiu, S, Chowdhury, F, Cook, AJ, Cooper, B, Cressey, TR, Criollo-Mora, E, Cunningham, M, Darboe, S, Day, NPJ, De Luca, M, Dokova, K, Dramowski, A, Dunachie, SJ, Eckmanns, T, Eibach, D, Emami, A, Feasey, N, Fisher-Pearson, N, Forrest, K, Garrett, D, Gastmeier, P, Giref, AZ, Greer, RC, Gupta, V, Haller, S, Haselbeck, A, Hay, S, Holm, M, Hopkins, S, Iregbu, KC, Jacobs, J, Jarovsky, D, Javanmardi, F, Khorana, M, Kissoon, N, Kobeissi, E, Kostyanev, T, Krapp, F, Krumkamp, R, Kumar, A, Kyu, HH, Lim, C, Limmathurotsakul, D, Loftus, MJ, Lunn, M, Ma, J, Mturi, N, Munera-Huertas, T, Musicha, P, Mussi-Pinhata, MM, Nakamura, T, Nanavati, R, Nangia, S, Newton, P, Ngoun, C, Novotney, A, Nwakanma, D, Obiero, CW, Olivas-Martinez, A, Olliaro, P, Ooko, E, Ortiz-Brizuela, E, Peleg, AY, Perrone, C, Plakkal, N, Ponce-de-Leon, A, Raad, M, Ramdin, T, Riddell, A, Roberts, T, VictoriaRobotham, J, Roca, A, Rudd, KE, Russell, N, Schnall, J, Scott, JAG, Shivamallappa, M, Sifuentes-Osornio, J, Steenkeste, N, Stewardson, AJ, Stoeva, T, Tasak, N, Thaiprakong, A, Thwaites, G, Turner, C, Turner, P, van Doorn, HR, Velaphi, S, Vongpradith, A, Huong, V, Walsh, T, Waner, S, Wangrangsimakul, T, Wozniak, T, Zheng, P, Sartorius, B, Lopez, AD, Stergachis, A, Moore, C, Dolecek, C, Naghavi, M, Murray, CJL, Ikuta, KS, Sharara, F, Swetschinski, L, Aguilar, GR, Gray, A, Han, C, Bisignano, C, Rao, P, Wool, E, Johnson, SC, Browne, AJ, Chipeta, MG, Fell, F, Hackett, S, Haines-Woodhouse, G, Hamadani, BHK, Kumaran, EAP, McManigal, B, Agarwal, R, Akech, S, Albertson, S, Amuasi, J, Andrews, J, Aravkin, A, Ashley, E, Bailey, F, Baker, S, Basnyat, B, Bekker, A, Bender, R, Bethou, A, Bielicki, J, Boonkasidecha, S, Bukosia, J, Carvalheiro, C, Castaneda-Orjuela, C, Chansamouth, V, Chaurasia, S, Chiurchiu, S, Chowdhury, F, Cook, AJ, Cooper, B, Cressey, TR, Criollo-Mora, E, Cunningham, M, Darboe, S, Day, NPJ, De Luca, M, Dokova, K, Dramowski, A, Dunachie, SJ, Eckmanns, T, Eibach, D, Emami, A, Feasey, N, Fisher-Pearson, N, Forrest, K, Garrett, D, Gastmeier, P, Giref, AZ, Greer, RC, Gupta, V, Haller, S, Haselbeck, A, Hay, S, Holm, M, Hopkins, S, Iregbu, KC, Jacobs, J, Jarovsky, D, Javanmardi, F, Khorana, M, Kissoon, N, Kobeissi, E, Kostyanev, T, Krapp, F, Krumkamp, R, Kumar, A, Kyu, HH, Lim, C, Limmathurotsakul, D, Loftus, MJ, Lunn, M, Ma, J, Mturi, N, Munera-Huertas, T, Musicha, P, Mussi-Pinhata, MM, Nakamura, T, Nanavati, R, Nangia, S, Newton, P, Ngoun, C, Novotney, A, Nwakanma, D, Obiero, CW, Olivas-Martinez, A, Olliaro, P, Ooko, E, Ortiz-Brizuela, E, Peleg, AY, Perrone, C, Plakkal, N, Ponce-de-Leon, A, Raad, M, Ramdin, T, Riddell, A, Roberts, T, VictoriaRobotham, J, Roca, A, Rudd, KE, Russell, N, Schnall, J, Scott, JAG, Shivamallappa, M, Sifuentes-Osornio, J, Steenkeste, N, Stewardson, AJ, Stoeva, T, Tasak, N, Thaiprakong, A, Thwaites, G, Turner, C, Turner, P, van Doorn, HR, Velaphi, S, Vongpradith, A, Huong, V, Walsh, T, Waner, S, Wangrangsimakul, T, Wozniak, T, Zheng, P, Sartorius, B, Lopez, AD, Stergachis, A, Moore, C, Dolecek, C, and Naghavi, M

Abstract

BACKGROUND: Antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen-drug combinations in select locations. To our knowledge, this study presents the most comprehensive estimates of AMR burden to date. METHODS: We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019. We obtained data from systematic literature reviews, hospital systems, surveillance systems, and other sources, covering 471 million individual records or isolates and 7585 study-location-years. We used predictive statistical modelling to produce estimates of AMR burden for all locations, including for locations with no data. Our approach can be divided into five broad components: number of deaths where infection played a role, proportion of infectious deaths attributable to a given infectious syndrome, proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antibiotic of interest, and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden based on two counterfactuals: deaths attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and deaths associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. We present final estimates aggregated to the global and regional level. FINDINGS: On the bas

Published
2022

29. Defining the scope of the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet): a bottom-up and One Health approach

Author

Mader, R., Demay, C., Jouvin-Marche, E., Ploy, M. -C., Barraud, O., Bernard, S., Lacotte, Y., Pulcini, C., Weinbach, J., Berling, C., Bouqueau, M., Hlava, A., Habl, C., Kernstock, E., Strauss, R., Muchl, R., Buhmann, V., Versporten, A., Ingenbleek, A., Vandael, E., Haelterman, G., De Raedt, L., Hunjak, B., Raickovic, B., Mackova, B., Niklova, E., Zemlickova, H., Hrivnakova, L., Jindrak, V., Kristensen, B., Lyndrup, M., Skovgaard, S., Wolf Sonksen, U., Aasmae, B., Ruut, J., Linnik, L., Sadikova, O., Martin, P., Zanuzdana, A., Kizilkaya-Guneser, G., Oezcelik, N., Eckmanns, T., Lambrou, A., Kontopidou, F., Papadaki, M., Tsana, M., Maroulis, N., Vatopoulos, A., Papadogiannakis, E., Kontarini, M., Gikas, A., Magkanaraki, A., Cozza, A., Martinelli, D., Fortunato, F., Prato, R., Marella, A. M., Pantosti, A., Prestinaci, F., Busani, L., Pezzoti, P., Creti, R., Martoccia, R. M., Brusaferro, S., Vilde, A., Jakovela, A., Langusa, E., Grudule, L., Grinsteine, M., Dumpis, U., Dambrauskiene, A., Vitkauskiene, A., Tirvaite, D., Cemnalianskis, L., Kazenaite, E., Lozoraitiene, I., Adomaitiene, R., Ambrazaitiene, R., Kiveryte, S., Maciulaityte, A., Kuklyte, J., Petrene, J., Valinteliene, R., Kanapeckiene, V., Razmiene, A., Kairiene, B., Aleksiene, G., Valinciute, G., Petraitis, R., Elsemulder, A., Nakched, A., Claessen, J., Gui, L., Kort, M. D., Peran, R., Van Leeuwen, A., Smeets, E., Mennen, M., Spruijt, P., Westerhof, R., Skulberg, A., Bakka, E. Ro., Miard, K., Henricsen, S. Ho., Pellerud, A., Kallberg, C., Ardal, C., Eriksen, H. -M., Kranstad, K., Molvik, M., Kacelnik, O., Sollund, P., Samuelsen, R., Bakke, T., Urdahl, A. M., Norstrom, M., Olczak-Pienkowska, A., Skoczynska, A., Zabicka, D., Bysiek, J., Rekawek, J., Lebre, A., Falcao, E., Scripcaru, G., Neves, I., Gomes, S., Pereira, N., Malutan, A. M., Iuhas, C., Szakacs, L., Kissiedou-Bob, M., Ciortea, R., Grilc, E., Klavs, I., Turk, K., Subelj, M., Vrdelja, M., Serdt, M., Jemec, N., Glavan, U., Simonovic, Z., Tamayo, A. N., Lopez Navas, A., Munoz Madero, C., Alonso Lebrero, J. L., Alonso Irujo, L., Santacreu Garcia, M., Crespo Robledo, P., Oliva, G., Massanes, M., Oliver Palomo, A., Garcia Pineda, A., Ferragut, E., Rojo, E., Castano, E., Perianez, L., Torres Cantero, A. M., Jimenez Guillen, C., Hukelova, H., Alcaraz, M., Carlos, M. A., Lopez Acuna, M. D. P., Gil Setas, A., Ibarrola Segura, A., Ezpeleta, C., Gahigiro Merino, C., Portillo Bordonabe, M. E., Fragoso, M., Beristain Rementeria, X., Penalva, G., Cisneros, J. M., Estevez, M., Monteau, S., Del Rio, L., Gonzalez De Suso, M. J., Gallego Berciano, P., Aranguren Oyarzabal, A., Alioto, D., Izquierdo Palomares, J. M., Calvo Alcantara, M. J., Gonzalez Perez, R., Havarria, T., Hulth, A., Carlin, K., Edman, L., Grape, M., Aspevall, O., Haggar, A., Lindal, E., Burgos, A., Ottoson, J., Ostman, M., Egervarn, M., Nordenfelt, A., Bengtsson, B., Soderman, I., Bjers, A., Jonsson, J. -I., Starborg, M., Laine, M., Fagerstedt, P., Metcalfe, A., Soder, J., Lytsy, B., Madec, J. Y., Collineau, L., Berger-Carbonne, A., Colomb-Cotinat, M., Bourely, C., Amat, J. -P., Broens, E. M., Callens, B., Crespo-Robledo, P., Damborg, P., Filippitzi, M. -E., Fitzgerald, W., Gronthal, T., Haenni, M., Heuvelink, A., Van Hout, J., Kaspar, H., Pedersen, K., Pokludova, L., Dal Pozzo, F., Slowey, R., Zafeiridis, C., Madec, J. -Y., and Departments of Faculty of Veterinary Medicine

Subjects
Microbiology (medical), Veterinary medicine, Staphylococcus pseudintermedius, 040301 veterinary sciences, Swine, Drug Resistance, 413 Veterinary science, 0403 veterinary science, Animals, Anti-Bacterial Agents, Bacteria, Cats, Cattle, Chickens, Dogs, Drug Resistance, Bacterial, Female, One Health, 03 medical and health sciences, Antibiotic resistance, Antimicrobial stewardship, Medicine, Pharmacology (medical), 2. Zero hunger, Streptococcus uberis, Pharmacology, 0303 health sciences, biology, 030306 microbiology, business.industry, Bacterial, 04 agricultural and veterinary sciences, biology.organism_classification, Antimicrobial, Food safety, 3. Good health, Infectious Diseases, business, Streptococcus dysgalactiae
Abstract

BackgroundBuilding the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet) was proposed to strengthen the European One Health antimicrobial resistance (AMR) surveillance approach.ObjectivesThe objectives were to (i) define the combinations of animal species, production types, age categories, bacterial species, specimens and antimicrobials to be monitored in EARS-Vet and to (ii) determine antimicrobial test panels able to cover most combinations.MethodsThe EARS-Vet scope was defined by consensus between 26 European experts. Decisions were guided by a survey of the combinations that are relevant and feasible to monitor in diseased animals in 13 European countries (bottom-up approach). Experts also considered the One Health approach and the need for EARS-Vet to complement existing European AMR monitoring systems coordinated by the European Centre for Disease Prevention and Control (ECDC) and the European Food Safety Authority (EFSA).ResultsEARS-Vet would monitor AMR in six animal species (cattle, swine, chicken (broiler and laying hen), turkey, cat and dog), for 11 bacterial species (Escherichia coli, Klebsiella pneumoniae, Mannheimia haemolytica, Pasteurella multocida, Actinobacillus pleuropneumoniae, Staphylococcus aureus, Staphylococcus pseudintermedius, Staphylococcus hyicus, Streptococcus uberis, Streptococcus dysgalactiae and Streptococcus suis). Relevant antimicrobials for their treatment were selected (e.g. tetracyclines) and complemented with antimicrobials of more specific public health interest (e.g. carbapenems). Three test panels of antimicrobials were proposed covering most EARS-Vet combinations of relevance for veterinary antimicrobial stewardship.ConclusionsWith this scope, EARS-Vet would enable to better address animal health in the strategy to mitigate AMR and better understand the multi-sectoral AMR epidemiology in Europe.

Published
2022

41. Reduktion von Antibiotikaresistenzen durch leitliniengerechte Behandlung von Patienten mit unkompliziertem Harnwegsinfekt in der ambulanten Versorgung – REDARES

Author

Jede, F, Bleidorn, J, Eckmanns, T, Heintze, C, Heuschmann, P, Klingeberg, A, Maun, A, Rücker, V, Schmiemann, G, Schuster, A, and Gágyor, I

Subjects
ddc: 610, 610 Medical sciences, Medicine
Abstract

Hintergrund: In Deutschland werden ambulant zur Behandlung des unkomplizierten Harnwegsinfekts (HWI) in über 40% der Fälle Antibiotika der zweiten Wahl eingesetzt. Um eine Veränderung des Verordnungsverhaltens zu erreichen, sollen in REDARES Leitlinienempfehlungen zur Behandlung [zum vollständigen Text gelangen Sie über die oben angegebene URL], 53. Kongress für Allgemeinmedizin und Familienmedizin

Published
2019
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46. 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

Author

Cassini, A, Hogberg, LD, Plachouras, D, Quattrocchi, A, Hoxha, A, Simonsen, GS, Colomb-Cotinat, M, Kretzschmar, ME, Devleesschauwer, B, Cecchini, M, Ouakrim, DA, Oliveira, TC, Struelens, MJ, Suetens, C, Monnet, DL, Strauss, R, Mertens, K, Struyf, T, Catry, B, Latour, K, Ivanov, IN, Dobreva, EG, Tambic Andrasevic, A, Soprek, S, Budimir, A, Paphitou, N, Zemlickova, H, Olsen, SS, Sonksen, UW, Martin, P, Ivanova, M, Lyytikainen, O, Jalava, J, Coignard, B, Eckmanns, T, Abu Sin, M, Haller, S, Daikos, GL, Gikas, A, Tsiodras, S, Kontopidou, F, Toth, A, Hajdu, A, Guolaugsson, O, Kristinsson, KG, Murchan, S, Burns, K, Dsstat, PP, Gagliotti, C, Dumpis, U, Liuimiene, A, Perrin, M, Borg, MA, de Greeff, SC, Monen, JCM, Koek, MBG, Elstrom, P, Zabicka, D, Deptula, A, Hryniewicz, W, Canica, M, Nogueira, PJ, Fernandes, PA, Manageiro, V, Popescu, GA, Serban, RI, Schreterova, E, Litvova, S, Stefkovicova, M, Kolman, J, Klavs, I, Korosec, A, Aracil, B, Asensio, A, Perez-Vazquez, M, Billstrom, H, Larsson, S, Reilly, JS, Johnson, A, Hopkins, S, Cassini, A, Hogberg, LD, Plachouras, D, Quattrocchi, A, Hoxha, A, Simonsen, GS, Colomb-Cotinat, M, Kretzschmar, ME, Devleesschauwer, B, Cecchini, M, Ouakrim, DA, Oliveira, TC, Struelens, MJ, Suetens, C, Monnet, DL, Strauss, R, Mertens, K, Struyf, T, Catry, B, Latour, K, Ivanov, IN, Dobreva, EG, Tambic Andrasevic, A, Soprek, S, Budimir, A, Paphitou, N, Zemlickova, H, Olsen, SS, Sonksen, UW, Martin, P, Ivanova, M, Lyytikainen, O, Jalava, J, Coignard, B, Eckmanns, T, Abu Sin, M, Haller, S, Daikos, GL, Gikas, A, Tsiodras, S, Kontopidou, F, Toth, A, Hajdu, A, Guolaugsson, O, Kristinsson, KG, Murchan, S, Burns, K, Dsstat, PP, Gagliotti, C, Dumpis, U, Liuimiene, A, Perrin, M, Borg, MA, de Greeff, SC, Monen, JCM, Koek, MBG, Elstrom, P, Zabicka, D, Deptula, A, Hryniewicz, W, Canica, M, Nogueira, PJ, Fernandes, PA, Manageiro, V, Popescu, GA, Serban, RI, Schreterova, E, Litvova, S, Stefkovicova, M, Kolman, J, Klavs, I, Korosec, A, Aracil, B, Asensio, A, Perez-Vazquez, M, Billstrom, H, Larsson, S, Reilly, JS, Johnson, A, and Hopkins, S

Abstract

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. Ou

Published
2019

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