MedicalResearch.com Interview with:
Dr Alessandro Cassini MD
Epidemiologist, European Centre for Disease Prevention and Control
MedicalResearch.com: What is the background for this study?
Response: We published an ECDC study estimating attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the European Union and the European Economic Area (EU/EEA). This study is based on 2015 data from the European Antimicrobial Resistance Surveillance Network (EARS-Net).
The study was developed by experts at ECDC and the Burden of AMR Collaborative Group, and published in The Lancet Infectious Diseases.
MedicalResearch.com: What are the main findings?
Response: Our study estimated that each year, 33000 people die as a direct consequence of an infection due to bacteria resistant to antibiotics. This represents a burden comparable to that of influenza, tuberculosis and HIV/AIDS combined.
We also found that 75% of the burden of bacteria resistant to antibiotics in Europe is due to healthcare-associated infections and 39% of the burden is caused by infections with bacteria resistant to last-line antibiotics such as carbapenems and colistin (generally in hospitals). This could be minimised through adequate infection prevention and control measures, as well as antibiotic stewardship in healthcare settings.
The burden of all studied infections with bacteria resistant to antibiotics increased between 2007 and 2015. The number of deaths attributable to infections with Klebsiella pneumoniae resistant to carbapenems – a group of last-line antibiotics – increased six-fold. This is a worrisome trend because these bacteria can spread easily in healthcare settings if adequate infection prevention and control measures are not in place. On the other hand, the number of deaths attributable to infections with third-generation cephalosporin-resistant Escherichia coli, that are mostly community-associated, increased four-fold. Moreover, these infections were responsible for the highest burden in 2015 indicating that antimicrobial stewardship targeting primary care prescribers as well as infection prevention and control interventions in primary care are necessary to reduce the burden of these infections.
MedicalResearch.com: What should readers take away from your report?
Response: 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. Strategies to prevent and control antibiotic-resistant bacteria require coordination at EU and 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 that are tailored to the needs of each country in the EU and EEA. Our study also showed that most of the burden of infections with antibiotic-resistant bacteria in the EU and EEA was healthcare-associated, thus emphasising the need to urgently address antimicrobial resistance as a patient safety issue and the need for alternative treatment options for patients with such infections who have comorbidities or are otherwise vulnerable (e.g., because of their poor immune system or age).
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future studies should include estimates of the burden of infections due to other antibiotic-resistant bacteria of public health importance, such as multidrug-resistant (MDR) and extensively drug-resistant (XDR) Mycobacterium tuberculosis, drug-resistant Salmonella spp., and drug-resistant Neisseria gonorrhoeae, to give a more comprehensive estimate of the burden of antimicrobial resistance. In the long term, research should be done to better understand the factors underlying the estimations of EARS-Net country coverage, such as catchment population, patient case-mix, laboratory capacity, and the appropriateness and frequency of collection of blood cultures in each country, thus providing data for even better models and estimates.
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, 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, Ólafur Guólaugsson, 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. 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, 2018; DOI: 10.1016/S1473-3099(18)30605-4
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