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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

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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.
Keywords
Infectious Diseases

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Chicago
Cassini, Alessandro, Liselotte Diaz Högberg, Diamantis Plachouras, Annalisa Quattrocchi, Ana Hoxha, Gunnar Skov Simonsen, Mélanie Colomb-Cotinat, et al. 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.
APA
Cassini, A., Högberg, L. D., Plachouras, D., Quattrocchi, A., Hoxha, A., Simonsen, G. S., Colomb-Cotinat, M., et al. (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.
Vancouver
1.
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. Elsevier BV; 2019;19(1):56–66.
MLA
Cassini, Alessandro, Liselotte Diaz Högberg, Diamantis Plachouras, 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 19.1 (2019): 56–66. Print.
@article{8586609,
  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\phantom{,}689 (95\% uncertainty interval [UI] 583\phantom{,}148--763\phantom{,}966) infections with antibiotic-resistant bacteria, of which 63{\textperiodcentered}5\% (426\phantom{,}277 of 671\phantom{,}689) were associated with health care. These infections accounted for an estimated 33\phantom{,}110 (28\phantom{,}480--38\phantom{,}430) attributable deaths and 874\phantom{,}541 (768\phantom{,}837--989\phantom{,}068) DALYs. The burden for the EU and EEA was highest in infants (aged {\textlangle}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.},
  author       = {Cassini, Alessandro and H{\"o}gberg, Liselotte Diaz and Plachouras, Diamantis and Quattrocchi, Annalisa and Hoxha, Ana and Simonsen, Gunnar Skov and Colomb-Cotinat, M{\'e}lanie and Kretzschmar, Mirjam E and Devleesschauwer, Brecht and Cecchini, Michele and Ouakrim, Driss Ait and Oliveira, Tiago Cravo and Struelens, Marc J and Suetens, Carl and Monnet, Dominique L and Strauss, Reinhild and Mertens, Karl and Struyf, Thomas and Catry, Boudewijn and Latour, Katrien and Ivanov, Ivan N and Dobreva, Elina G and Tambic Andra\v{s}evic, Arjana and Soprek, Silvija and Budimir, Ana and Paphitou, Niki and \v{Z}emlickov{\'a}, Helena and Schytte Olsen, Stefan and Wolff S{\"o}nksen, Ute and M{\"a}rtin, Pille and Ivanova, Marina and Lyytik{\"a}inen, Outi and Jalava, Jari and Coignard, Bruno and Eckmanns, Tim and Abu Sin, Muna and Haller, Sebastian and Daikos, George L and Gikas, Achilleas and Tsiodras, Sotirios and Kontopidou, Flora and T{\'o}th, {\'A}kos and Hajdu, {\'A}gnes and Gu{\'o}laugsson, {\'O}lafur and Kristinsson, Karl G and Murchan, Stephen and Burns, Karen and Pezzotti, Patrizio and Gagliotti, Carlo and Dumpis, Uga and Liuimiene, Agne and Perrin, Monique and Borg, Michael A and de Greeff, Sabine C and Monen, Jos CM and Koek, Mayke BG and Elstr{\o}m, Petter and Zabicka, Dorota and Deptula, Aleksander and Hryniewicz, Waleria and Cani\c{c}a, Manuela and Nogueira, Paulo Jorge and Fernandes, Paulo Andr{\'e} and Manageiro, Vera and Popescu, Gabriel A and Serban, Roxana I and Schr{\'e}terov{\'a}, Eva and Litvov{\'a}, Slavka and \v{S}tefkovicov{\'a}, M{\'a}ria and Kolman, Jana and Klavs, Irena and Koro\v{s}ec, Ale\v{s} and Aracil, Bel{\'e}n and Asensio, Angel and P{\'e}rez-V{\'a}zquez, Mar{\'i}a and Billstr{\"o}m, Hanna and Larsson, Sofie and Reilly, Jacqui S and Johnson, Alan and Hopkins, Susan},
  issn         = {1473-3099},
  journal      = {The Lancet Infectious Diseases},
  keyword      = {Infectious Diseases},
  number       = {1},
  pages        = {56--66},
  publisher    = {Elsevier BV},
  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},
  url          = {http://dx.doi.org/10.1016/s1473-3099(18)30605-4},
  volume       = {19},
  year         = {2019},
}

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