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; Burden of AMR Collaborative Group

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

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, Burden of AMR Collaborative Group

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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. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases.

FUNDING: European Centre for Disease Prevention and Control.

Original language	English
Pages (from-to)	56-66
Number of pages	11
Journal	The Lancet Infectious Diseases
Volume	19
Issue number	1
Early online date	5 Nov 2018
DOIs	https://doi.org/10.1016/S1473-3099(18)30605-4
Publication status	Published - Jan 2019

Keywords

infection
antibiotic resistance
modelling

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/S1473-3099(18)30605-4

Cassini, A. et al (2018) 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
© The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Final published version, 1.04 MBLicence: CC BY

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Cassini, A., Högberg, L. D., Plachouras, D., Quattrocchi, A., Hoxha, A., Simonsen, G. S., Colomb-Cotinat, M., Kretzschmar, M. E., Devleesschauwer, B., Cecchini, M., Ouakrim, D. A., Oliveira, T. C., Struelens, M. J., Suetens, C., Monnet, D. L., & Burden of AMR Collaborative Group (2019). 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. The Lancet Infectious Diseases, 19(1), 56-66. https://doi.org/10.1016/S1473-3099(18)30605-4

Cassini, Alessandro ; Högberg, Liselotte Diaz ; Plachouras, Diamantis ; Quattrocchi, Annalisa ; Hoxha, Ana ; Simonsen, Gunnar Skov ; Colomb-Cotinat, Mélanie ; Kretzschmar, Mirjam E. ; Devleesschauwer, Brecht ; Cecchini, Michele ; Ouakrim, Driss Ait ; Oliveira, Tiago Cravo ; Struelens, Marc J. ; Suetens, Carl ; Monnet, Dominique L. ; Burden of AMR Collaborative Group. / 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. In: The Lancet Infectious Diseases. 2019 ; Vol. 19, No. 1. pp. 56-66.

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title = "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",

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. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases.FUNDING: European Centre for Disease Prevention and Control.",

keywords = "infection, antibiotic resistance, modelling",

author = "Alessandro Cassini and H{\"o}gberg, {Liselotte Diaz} and Diamantis Plachouras and Annalisa Quattrocchi and Ana Hoxha and Simonsen, {Gunnar Skov} and M{\'e}lanie Colomb-Cotinat and Kretzschmar, {Mirjam E.} and Brecht Devleesschauwer and Michele Cecchini and Ouakrim, {Driss Ait} and Oliveira, {Tiago Cravo} and Struelens, {Marc J.} and Carl Suetens and Monnet, {Dominique L.} and {Burden of AMR Collaborative Group} and Jacqui Reilly",

note = "OA article Acceptance note in SAN Note - originally we added J. Reilly as an author so that it could be saved. However this GCU author is part of the group author collaboration. ET 20/2/20 ",

year = "2019",

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language = "English",

volume = "19",

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journal = "The Lancet Infectious Diseases",

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Cassini, A, Högberg, 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 & Burden of AMR Collaborative Group 2019, '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', The Lancet Infectious Diseases, vol. 19, no. 1, pp. 56-66. https://doi.org/10.1016/S1473-3099(18)30605-4

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. / Cassini, Alessandro; Högberg, Liselotte Diaz; Plachouras, Diamantis; Quattrocchi, Annalisa; Hoxha, Ana; Simonsen, Gunnar Skov; Colomb-Cotinat, Mélanie; Kretzschmar, Mirjam E.; Devleesschauwer, Brecht; Cecchini, Michele; Ouakrim, Driss Ait; Oliveira, Tiago Cravo; Struelens, Marc J.; Suetens, Carl; Monnet, Dominique L.; Burden of AMR Collaborative Group.

In: The Lancet Infectious Diseases, Vol. 19, No. 1, 01.2019, p. 56-66.

Research output: Contribution to journal › Article › peer-review

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T1 - 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

AU - Cassini, Alessandro

AU - Högberg, Liselotte Diaz

AU - Plachouras, Diamantis

AU - Quattrocchi, Annalisa

AU - Hoxha, Ana

AU - Simonsen, Gunnar Skov

AU - Colomb-Cotinat, Mélanie

AU - Kretzschmar, Mirjam E.

AU - Devleesschauwer, Brecht

AU - Cecchini, Michele

AU - Ouakrim, Driss Ait

AU - Oliveira, Tiago Cravo

AU - Struelens, Marc J.

AU - Suetens, Carl

AU - Monnet, Dominique L.

AU - Burden of AMR Collaborative Group

AU - Reilly, Jacqui

N1 - OA article Acceptance note in SAN Note - originally we added J. Reilly as an author so that it could be saved. However this GCU author is part of the group author collaboration. ET 20/2/20

PY - 2019/1

Y1 - 2019/1

N2 - 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.

AB - 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.

KW - infection

KW - antibiotic resistance

KW - modelling

U2 - 10.1016/S1473-3099(18)30605-4

DO - 10.1016/S1473-3099(18)30605-4

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JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

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Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS et al. 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. The Lancet Infectious Diseases. 2019 Jan;19(1):56-66. https://doi.org/10.1016/S1473-3099(18)30605-4

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

Abstract

Keywords

UN SDGs

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