Antibiotic-Resistant Infections Doubled Since 2007 in Europe

More than 33,000 people died from antibiotic-resistant bacterial infections in the European Union and European Economic Area (EU/EEA) during 2015, a study has found. The estimated burden of these infections has doubled since 2007 and was similar to the combined burden of influenza, tuberculosis, and HIV. Most of the estimated burden was in hospitals and other healthcare settings, suggesting an “urgent need to 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 (eg, because of their poor immune system or age),” the authors explain.

Alessandro Cassini, MD, from the European Centre for Disease Prevention and Control, Solna, Sweden, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands, and colleagues published their findings online November 5 in The Lancet.

The investigators estimated the incidence of infections with 16 antibiotic resistance-bacterium combinations from European Antimicrobial Resistance Surveillance Network 2015 data. They used systematic literature reviews to develop disease outcome models for five types of infection and used Monte Carlo simulations on 2400 disease models to provide estimates of disability-adjusted life-years (DALYs).

The researchers estimate there were 671,689 (95% uncertainty interval [UI], 583,148 — 763,966) infections with antibiotic-resistant bacteria in 2015. Of those, 63.5% were linked to healthcare, causing 72.4% (23,976 of 33,110) of attributable deaths and 74.9% (127 of 180) of DALYs per 100,000 population.

The incidence of antibiotic-resistant infections was 131 (95% UI, 113 - 149) per 100,000 population, with an attributable mortality of 6.44 (95% UI, 5.54 - 7.48) deaths per 100,000 population and 170 (95% UI, 150 - 192) DALYs per 100,000 population.

Four antibiotic-resistant bacteria had the largest effect on health and accounted for 67.9% of DALYs: third-generation cephalosporin-resistant Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Pseudomonas aeruginosa, and third-generation cephalosporin-resistant Klebsiella pneumoniae.

Infections with colistin- or carbapenem-resistant bacteria were responsible for 38.7% (65.9 of 170) of total DALYs per 100,000.

“Despite its relatively low incidence, carbapenem-resistant K. pneumoniae had a high burden of disease because of its high attributable mortality, whereas vancomycin-resistant Enterococcus faecalis and E. faecium (which had a similar incidence to carbapenem-resistant K. pneumoniae) was associated with a low burden of disease,” the authors explain.

Infants younger than 1 year experienced the highest burden, followed by those aged 65 years or older.

antibiotic-resistant infections, European Antimicrobial Resistance Surveillance Network, EARS