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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

question:do you think the research described in the jornal paper assigned this weerk progressed the reasearch area ? why or why not ?

Answer 1

Yes I think the research described in the jornal paper progressed the reasearch area.

Evidence before this study:

Estimates of the incidence, attributable mortality, attributable length of stay, and attributable disability-adjusted life-years (DALYs) of all infection types with antibiotic-resistant bacteria are scarce. Previous studies estimating the burden of infections with antibiotic-resistant bacteria were either restricted in their geographical scope, number of infections, or types of infections. Reports were published by the European Centre for Disease Prevention and Control in 2009, the US Centers for Disease Control and Prevention in 2013, and the UK Review on Antimicrobial Resistance in 2014, but these were not peer-reviewed. Challenges when estimating the incidence of diseases include poor availability of data, heterogeneous sampling and microbiological procedures for testing of the isolates, data collection processes, and differences on how surveillance systems are structured. Moreover, quantifying the risk of death or other clinical outcomes following an infection with an antibiotic-resistant bacteria, which generally occurs in patients affected by other diseases, is challenging and its attribution is debateable. To their knowledge, data on the burden of infections with antibiotic-resistant bacteria expressed by a composite health measure to compare with the effect of other diseases, have not been published before.

Added value of this study:

EU and European Economic Area (EEA) countries report data to the European Antimicrobial Resistance Surveillance Network (EARS-Net) on bloodstream infections with antibiotic-resistant bacteria in a coherent and standardised manner. On the basis of EARS-Net data, here they developed a step-wise approach, involving other data sources (such as the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections and antimicrobial use in European acute care hospitals in 2011–12), to determine the country-specific incidence of infections with antibiotic-resistant bacteria of public health importance in 2015. They have done systematic reviews of the literature, including a standardised approach to the selection and extraction of the evidence, to inform the attributable mortality and attributable length of stay of each antibiotic resistance–bacterium combination. Finally, Monte Carlo simulations on 2400 disease models provided estimates of DALYs, which could be placed within the general context of the burden of other diseases.

Implications of all the available evidence:

The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA was similar to the cumulative burden of influenza, tuberculosis, and HIV, was notably diverse across countries, and has increased between 2007 and 2015. Strategies to prevent and control antibiotic-resistant bacteria require coordination at EU and EEA and global levels, and interventions that are tailored to national and local challenges. This publication finding that most of the estimated burden was in hospitals and other health-care settings suggests the 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).