Abstract
BackgroundHealthcare-associated infections (HAIs) pose a major challenge to health systems. Burden of disease estimations in disability-adjusted life years (DALYs) are useful for comparing and ranking HAIs.AimTo estimate the number of five common HAIs, their attributable number of deaths and burden for Germany.MethodsWe developed a new method and R package that builds on the approach used by the Burden of Communicable Diseases in Europe (BCoDE) project to estimate the burden of HAIs for individual countries. We used data on healthcare-associated Clostridioides difficile infection, healthcare-associated pneumonia, healthcare-associated primary bloodstream infection, healthcare-associated urinary tract infection and surgical-site infection, which were collected during the point prevalence survey of HAIs in European acute-care hospitals between 2011 and 2012.ResultsWe estimated 478,222 (95% uncertainty interval (UI): 421,350–537,787) cases for Germany, resulting in 16,245 (95% UI: 10,863–22,756) attributable deaths and 248,920 (95% UI: 178,693–336,239) DALYs. Despite the fact that Germany has a relatively low hospital prevalence of HAIs compared with the European Union/European Economic Area (EU/EEA) average, the burden of HAIs in Germany (308.2 DALYs/100,000 population; 95% UI: 221.2–416.3) was higher than the EU/EEA average (290.0 DALYs/100,000 population; 95% UI: 214.9–376.9). Our methodology is applicable to other countries in or outside of the EU/EEA. An R package is available from https://CRAN.R-project.org/package=BHAI.ConclusionThis is the first study to estimate the burden of HAIs in DALYs for Germany. The large number of hospital beds may be a contributing factor for a relatively high burden of HAIs in Germany. Further focus on infection prevention control, paired with reduction of avoidable hospital stays, is needed to reduce the burden of HAIs in Germany.
Highlights
Healthcare-associated infections (HAIs) are associated with an increased risk in morbidity, mortality and excess healthcare costs
Note that the sum of the median years lived with disability (YLDs) and years of life lost (YLLs) does not exactly equal the median disability-adjusted life years (DALYs). This is because the sum of the median of two distributions (i.e. YLDs and YLLs for all 1,000 simulations) is not necessarily equal to the median of the sum of the distributions (i.e. DALYs calculated as YLD + YLL for each simulation)
healthcare-associated pneumonia (HAP) and bloodstream infection (BSI) accounted for 51% (127,858 DALYs/248,920 DALYs) of the burden of HAIs, but accounted for only 28% (133,562 cases/478,222 cases) of the estimated number of HAIs (Figure 2)
Summary
Healthcare-associated infections (HAIs) are associated with an increased risk in morbidity, mortality and excess healthcare costs. The European Centre for Disease Prevention and Control (ECDC) published the first estimates of the health burden attributable to HAIs in the European Union and European Economic Area (EU/EEA) in 2016 [3]. It used the same incidence-based approach as the ECDC Burden of Communicable Diseases in PPS sample. Results: We estimated 478,222 (95% uncertainty interval (UI): 421,350–537,787) cases for Germany, resulting in 16,245 (95% UI: 10,863–22,756) attributable deaths and 248,920 (95% UI: 178,693–336,239) DALYs. Despite the fact that Germany has a relatively low hospital prevalence of HAIs compared with the European Union/European Economic Area (EU/EEA) average, the burden of HAIs in Germany (308.2 DALYs/100,000 population; 95% UI: 221.2–416.3) was higher than the EU/EEA average (290.0 DALYs/100,000 population; 95% UI: 214.9–376.9). An R package is available from https://CRAN.R-project.org/ package=BHAI
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