Abstract
The relative importance of human diseases is conventionally assessed by cause-specific mortality, morbidity, and economic impact. Current estimates for infections caused by antibiotic-resistant bacteria are not sufficiently supported by quantitative empirical data. This study determined the excess number of deaths, bed-days, and hospital costs associated with blood stream infections (BSIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) and third-generation cephalosporin-resistant Escherichia coli (G3CREC) in 31 countries that participated in the European Antimicrobial Resistance Surveillance System (EARSS). The number of BSIs caused by MRSA and G3CREC was extrapolated from EARSS prevalence data and national health care statistics. Prospective cohort studies, carried out in hospitals participating in EARSS in 2007, provided the parameters for estimating the excess 30-d mortality and hospital stay associated with BSIs caused by either MRSA or G3CREC. Hospital expenditure was derived from a publicly available cost model. Trends established by EARSS were used to determine the trajectories for MRSA and G3CREC prevalence until 2015. In 2007, 27,711 episodes of MRSA BSIs were associated with 5,503 excess deaths and 255,683 excess hospital days in the participating countries, whereas 15,183 episodes of G3CREC BSIs were associated with 2,712 excess deaths and 120,065 extra hospital days. The total costs attributable to excess hospital stays for MRSA and G3CREC BSIs were 44.0 and 18.1 million Euros (63.1 and 29.7 million international dollars), respectively. Based on prevailing trends, the number of BSIs caused by G3CREC is likely to rapidly increase, outnumbering the number of MRSA BSIs in the near future. Excess mortality associated with BSIs caused by MRSA and G3CREC is significant, and the prolongation of hospital stay imposes a considerable burden on health care systems. A foreseeable shift in the burden of antibiotic resistance from Gram-positive to Gram-negative infections will exacerbate this situation and is reason for concern.
Highlights
Managing increasingly limited resources is one of the key challenges in contemporary health care
Excess mortality associated with blood stream infection (BSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) and thirdgeneration cephalosporin-resistant Escherichia coli (G3CREC) is significant, and the prolongation of hospital stay imposes a considerable burden on health care systems
Excess hospital stay, and the related hospital expenditure associated with methicillin-resistant S. aureus (MRSA) and third-generation cephalosporin-resistant E. coli (G3CREC) bacteremias, and provide trend-based trajectories until 2015 for all countries that participated in European Antimicrobial Resistance Surveillance System (EARSS) in 2007
Summary
Managing increasingly limited resources is one of the key challenges in contemporary health care. In order to inform the public health debate in Europe and beyond, reliable estimates about excess mortality, morbidity, and costs are imperative Data about this burden of disease (BoD) will enable evaluation of antimicrobial resistance (AMR) against other competing causes of morbidity and mortality. With some notable exceptions such as TB, HIV, malaria, and gonorrhea, most of the disease burden attributable to antimicrobial resistance is caused by hospitalassociated infections due to opportunistic bacterial pathogens These bacteria often cause life-threatening or difficult-tomanage conditions such as deep tissue, wound, or bone infections, or infections of the lower respiratory tract, central nervous system, or blood stream. The researchers proposed to fill this information gap by estimating the impact—morbidity, mortality, and demands on health care services—of antibiotic resistance in Europe for two types of resistant organisms that are typically associated with resistance to multiple classes of antibiotics and can be regarded as surrogate markers for multi-drug resistance—methicillin-resistant S. aureus and third-generation cephalosporin-resistant E. coli
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