Tuesday, November 06, 2018

The Lancet: Attributable Deaths & Disability Due To Infections With Antibiotic-Resistant Bacteria - EU 2015



Next week is the US and World Antibiotic Awareness week, and during this time each year we tend to see some big studies released on the growing problem of antibiotic and antimicrobial resistance.
Short of experiencing a truly severe pandemic, there is probably no greater public health threat on the horizon than the steady loss of our antibiotic armamentarium.
Each year we see new, resistant, organisms emerge - and each year we draw a little bit closer to a dreaded, but plausible `post-antibiotic era'.  And while antibiotics still work for most infections, for tens of thousands of people every year, that `post-antibiotic era' is already here. 

Great efforts are going on by many nations to improve antimicrobial stewardship and help stave off that day (see CIDRAP's Antimicrobial Stewardship Project), but inappropriate prescribing or use of  antibiotics, rampant (and unnecessary) use in farm animals, and the plethora of fake or adulterated antibiotics sold around the world continue to take their toll.

A few past blogs include:
The Lancet: WHO Estimates That 50% Of Drugs For Sale Online Are Fake

mBio: The Gathering Storm: Is Untreatable Typhoid Fever on the Way?
Global AMR Threat: Centrally Approved & Unapproved Antibiotic Formulations Sold In India

WHO: First Global Antimicrobial Surveillance System (GLASS) Report
WHO: The World Is Running Out Of Antibiotics

Today The Lancet has published a new, open-access study, on the burden of antibiotic resistant infections in the EU (2015), which is summarized in the ECDC news report below.  Beneath that you'll find the abstract and link to the full PDF, after which I'll have a brief postscript:

33000 people die every year due to infections with antibiotic-resistant bacteria

6 Nov 2018

An ECDC study estimates the burden of five types of infections caused by antibiotic-resistant bacteria of public health concern in the European Union and in the European Economic Area (EU/EEA).

The burden of disease is measured in number of cases, attributable deaths and disability-adjusted life years (DALYs). These estimates are based on data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) data from 2015.

The authors said “the estimated burden of infections with antibiotic-resistant bacteria in the EU/EEA is substantial compared to that of other infectious diseases, and increased since 2007. Strategies to prevent and control antibiotic-resistant bacteria require coordination at EU/EEA and global level. However, our study showed that the contribution of various antibiotic-resistant bacteria to the overall burden varies greatly between countries, thus highlighting the need for prevention and control strategies tailored to the need of each EU/EEA country”.

The study estimates that about 33000 people die each year as a direct consequence of an infection due to bacteria resistant to antibiotics and that the burden of these infections is comparable to that of influenza, tuberculosis and HIV/AIDS combined. It also explains that 75% of the burden of disease is due to healthcare-associated infections (HAIs) and that reducing this through adequate infection prevention and control measures, as well as antibiotic stewardship, could be an achievable goal in healthcare settings.

Finally, the study shows that 39% of the burden is caused by infections with bacteria resistant to last-line antibiotics such as carbapenems and colistin. This is an increase from 2007 and is worrying because these antibiotics are the last treatment options available. When these are no longer effective, it is extremely difficult or, in many cases, impossible to treat infections. 

The study was developed by experts at ECDC and the Burden of AMR Collaborative Group, and published in The Lancet Infectious Diseases. The results of this study are also used by the Organisation for Economic Co-operation and Development (OECD) to estimate the economic burden of antibiotic resistance.

The abstract and link to the full study is below:
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
Alessandro Cassini, Liselotte Diaz Högberg, Diamantis Plachouras, Annalisa Quattrocchi, Ana Hoxha, Gunnar Skov Simonsen, Mélanie Colomb-Cotinat, Mirjam E Kretzschmar, Brecht Devleesschauwer, Michele Cecchini, Driss Ait Ouakrim, Tiago Cravo Oliveira, Marc J Struelens, Carl Suetens, Dominique L Monnet, and the Burden of AMR Collaborative Group*


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). 


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. 


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.

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.
Copyright © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
(Continue . . . )

While I cover AMR topics occasionally in this blog, I can heartily recommend CIDRAP's Antimicrobial Stewardship Project as the best place to learn about this looming global threat of AMR.

You'll also want to check out the CIDRAP-ASP Youtube Channel, which has more than 24 hours of lectures and webinars on Antimicrobial stewardship.

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