Attributable #deaths and #disability-adjusted life-years caused by #infections with #antibiotic-resistant bacteria in the #EU and the #EEA in 2015: a population-level modelling analysis (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

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

Alessandro Cassini, MD,  Liselotte Diaz Högberg, PhD, Diamantis Plachouras, PhD, Annalisa Quattrocchi, PhD, Ana Hoxha, MSc, Gunnar Skov Simonsen, PhD, Mélanie Colomb-Cotinat, PhD, Mirjam E Kretzschmar, PhD, Brecht Devleesschauwer, PhD, Michele Cecchini, PhD, Driss Ait Ouakrim, PhD, Tiago Cravo Oliveira, PhD, Marc J Struelens, PhD, Carl Suetens, MD, Dominique L Monnet, PhD, theBurden of AMR Collaborative Group †

Open Access / Published: November 05, 2018 / DOI: https://doi.org/10.1016/S1473-3099(18)30605-4

 

Summary

Background

Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs).

Methods

We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature.

Findings

From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece.

Interpretation

Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. 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. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases.

Funding

European Centre for Disease Prevention and Control.

Keywords: Antibiotics; Drugs Resistance; EU; Excess mortality.

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#Comparison of 2016–17 and Previous #Epizootics of Highly Pathogenic #Avian #Influenza #H5 #Guangdong Lineage in #Europe (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 24, Number 12—December 2018 / Research

Comparison of 2016–17 and Previous Epizootics of Highly Pathogenic Avian Influenza H5 Guangdong Lineage in Europe

Pablo Alarcon1, Adam Brouwer1, Divya Venkatesh, Daisy Duncan, Chrysostomos I. Dovas, George Georgiades, Isabella Monne, Alice Fusaro, Adam Dan, Krzysztof Śmietanka, Vassilios Ragias, Andrew C. Breed, Taxiarchis Chassalevris, Gabriela Goujgoulova, Charlotte Kristiane Hjulsager, Eoin Ryan, Azucena Sánchez, Eric Niqueux, Niina Tammiranta, Siamak Zohari, David A. Stroud, Vladimir Savić, Nicola S. Lewis, and Ian H. Brown

Author affiliations: Royal Veterinary College, London, UK (P. Alarcon); Animal and Plant Health Agency, Addlestone, UK (P. Alarcon, A. Brouwer, D. Duncan, A.C. Breed, N.S. Lewis, I.H. Brown); University of Cambridge, Cambridge, U K (D. Venkatesh); Aristotle University of Thessaloniki, Thessaloniki, Greece (C.I. Dovas, T. Chassalevris); Ministry of Rural Development and Food, Thessaloniki (G. Georgiades, V. Ragias); Istituto Zooprofilattico Sperimentale delle Venezie, Padova, Italy (I. Monne, A. Fusaro); Veterinary Diagnostic Institute, Budapest, Hungary (A. Dan); National Veterinary Research Institute, Pulawy, Poland (K. Śmietanka); Department of Agriculture and Water Resources, Canberra, Australian Capital Territory, Australia (A.C. Breed); University of Queensland, Brisbane, Queensland, Australia (A.C. Breed); NDRVMI, Sofia, Bulgaria (G. Goujgoulova); Technical University of Denmark, Lyngby, Denmark (C.K. Hjulsager); Central Veterinary Research Laboratory, Celbridge, Ireland (E. Ryan); Central Veterinary Laboratory, Madrid, Spain (A. Sánchez); French Agency for Food, Environmental and Occupational Health & Safety, Ploufragan, France (E. Niqueux); Finnish Food Safety Authority Evira, Helsinki, Finland (N. Tammiranta); National Veterinary Institute and World Organisation for Animal Health Collaborating Center, Uppsala, Sweden (S. Zohari); Joint Nature Conservation Committee, Peterborough, UK (D. Stroud); Croatian Veterinary Institute, Zagreb, Croatia (V. Savić)

 

Abstract

We analyzed the highly pathogenic avian influenza (HPAI) H5 epizootic of 2016–17 in Europe by epidemiologic and genetic characteristics and compared it with 2 previous epizootics caused by the same H5 Guangdong lineage. The 2016–17 epizootic was the largest in Europe by number of countries and farms affected and greatest diversity of wild birds infected. We observed significant differences among the 3 epizootics regarding region affected, epidemic curve, seasonality, and outbreak duration, making it difficult to predict future HPAI epizootics. However, we know that in 2005–06 and 2016–17 the initial peak of wild bird detections preceded the peak of poultry outbreaks within Europe. Phylogenetic analysis of 2016–17 viruses indicates 2 main pathways into Europe. Our findings highlight the need for global surveillance of viral changes to inform disease preparedness, detection, and control.

Keywords: Avian Influenza; H5; Poultry; Wild Birds; European Region.

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#Upsurge in #echovirus 30 detections in five #EU/EEA countries, April to September, 2018 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Upsurge in echovirus 30 detections in five EU/EEA countries, April to September, 2018

Eeva K Broberg1, Benedetto Simone1, Josep Jansa1, the EU/EEA Member State contributors1

Affiliations: 1 European Centre for Disease Prevention and Control, Stockholm, Sweden

Citation style for this article: Broberg Eeva K, Simone Benedetto, Jansa Josep, the EU/EEA Member State contributors. Upsurge in echovirus 30 detections in five EU/EEA countries, April to September, 2018. Euro Surveill. 2018;23(44):pii=1800537. https://doi.org/10.2807/1560-7917.ES.2018.23.44.1800537

Received: 02 Oct 2018;   Accepted: 30 Oct 2018

 

Abstract

An upsurge in Echovirus 30 (E30) infections, associated with meningitis/meningoencephalitis, has been observed in Denmark, Germany, the Netherlands, Norway and Sweden in the period April to September 2018, compared with 2015–2017. In total, 658 E30 infections among 4,537 enterovirus infections were detected in 15 countries between January and September 2018 and affected mainly newborns and 26–45 year-olds. National public health institutes are reminded to remain vigilant and inform clinicians of the ongoing epidemic.

©   This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Echovirus 30; Enterovirus; Viral meningitis; Encephalitis; European Region.

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Effect of childhood #pneumococcal conjugate #vaccination on invasive disease in older #adults of 10 #European countries: implications for adult vaccination (Thorax, abstract)

[Source: Thorax, full page: (LINK). Abstract, edited.]

Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination

Germaine Hanquet1,2, Pavla Krizova3, Palle Valentiner-Branth4, Shamez N Ladhani5, J Pekka Nuorti6,7, Agnes Lepoutre8, Jolita Mereckiene9, Mirjam Knol10, Brita A Winje11, Pilar Ciruela12,13, Maria Ordobas14, Marcela Guevara13,15, Eisin McDonald16, Eva Morfeldt17, Jana Kozakova3, Hans-Christian Slotved4, Norman K Fry5, Hanna Rinta-Kokko6, Emmanuelle Varon18, Mary Corcoran19, Arie van der Ende20, Didrik F Vestrheim11, Carmen Munoz-Almagro13,21, Pello Latasa14, Jesus Castilla13,15, Andrew Smith22, Birgitta Henriques-Normark17,23,24, Robert Whittaker25, Lucia Pastore Celentano25, Camelia Savulescu1 on behalf of The SpIDnet/I-MOVE+ Pneumo Group

Author affiliations: 1 EpiConcept, Paris, France; 2 Antwerp University, Antwerp, Belgium; 3 National Institute of Public Health, Prague, Czech Republic; 4 Statens Serum Institut, Copenhagen, Denmark; 5 Public Health England, London, UK; 6 National Institute for Health and Welfare, Helsinki, Finland; 7 University of Tampere, Tampere, Finland; 8 Santé publique France, Saint-Maurice, France; 9 Health Protection Surveillance Centre, Dublin, Ireland; 10 National Institute for Public Health and the Environment, Bilthoven, The Netherlands; 11 Norwegian Institute of Public Health, Oslo, Norway; 12 Public Health Agency of Catalunya, Barcelona, Spain; 13 CIBER Epidemiología y Salud Pública, Madrid, Spain; 14 General Directorate of Public Health, Madrid, Spain; 15 Instituto de Salud Pública de Navarra – IdiSNA, Pamplona, Spain; 16 Health Protection Scotland, National Services Scotland, Glasgow, UK; 17 Public Health Agency of Sweden, Solna, Sweden; 18 National Centre for Pneumococci, European Hospital George Pompidou, Paris, France; 19 Irish Pneumococcal Reference Laboratory, Temple Street Children’s University Hospital, Dublin, Ireland; 20 Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Centre, Amsterdam, The Netherlands; 21 Instituto de Recerca Pediátrica, Hospital Sant Joan de Deu, Universitat Internacional de Catalunya, Barcelona, Spain; 22 Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, UK; 23 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; 24 Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; 25 European Centre for Disease Prevention and Control, Stockholm, Sweden

Correspondence to Dr Germaine Hanquet, Epidemiology Department, EpiConcept, Paris 75012, France; ghanquet@skynet.be

 

Abstract

Background 

Pneumococcal conjugate vaccines (PCVs) have the potential to prevent pneumococcal disease through direct and indirect protection. This multicentre European study estimated the indirect effects of 5-year childhood PCV10 and/or PCV13 programmes on invasive pneumococcal disease (IPD) in older adults across 13 sites in 10 European countries, to support decision-making on pneumococcal vaccination policies.

Methods 

For each site we calculated IPD incidence rate ratios (IRR) in people aged ≥65 years by serotype for each PCV10/13 year (2011–2015) compared with 2009 (pre-PCV10/13). We calculated pooled IRR and 95% CI using random-effects meta-analysis and PCV10/13 effect as (1 − IRR)*100.

Results 

After five PCV10/13 years, the incidence of IPD caused by all types, PCV7 and additional PCV13 serotypes declined 9% (95% CI −4% to 19%), 77% (95% CI 67% to 84%) and 38% (95% CI 19% to 53%), respectively, while the incidence of non-PCV13 serotypes increased 63% (95% CI 39% to 91%). The incidence of serotypes included in PCV13 and not in PCV10 decreased 37% (95% CI 22% to 50%) in six PCV13 sites and increased by 50% (95% CI −8% to 146%) in the four sites using PCV10 (alone or with PCV13). In 2015, PCV13 serotypes represented 20–29% and 32–53% of IPD cases in PCV13 and PCV10 sites, respectively.

Conclusion 

Overall IPD incidence in older adults decreased moderately after five childhood PCV10/13 years in 13 European sites. Large declines in PCV10/13 serotype IPD, due to the indirect effect of childhood vaccination, were countered by increases in non-PCV13 IPD, but these declines varied according to the childhood vaccine used. Decision-making on pneumococcal vaccination for older adults must consider the indirect effects of childhood PCV programmes. Sustained monitoring of IPD epidemiology is imperative.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

DOI: http://dx.doi.org/10.1136/thoraxjnl-2018-211767

Keywords: S. Pneumoniae; Vaccines; European Region; Invasive Pneumococcal Disease.

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Quantifying the #burden of #stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 #European countries (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Quantifying the burden of stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 European countries

Lucy K Smith, PhD, Ashna D Hindori-Mohangoo, PhD, Marie Delnord, PhD, Mélanie Durox, MSc, Prof Katarzyna Szamotulska, PhD, Prof Alison Macfarlane, CStat, et al.

Published: September 27, 2018 / DOI: https://doi.org/10.1016/S0140-6736(18)31651-9

 

Summary

Background

International comparisons of stillbirth allow assessment of variations in clinical practice to reduce mortality. Currently, such comparisons include only stillbirths from 28 or more completed weeks of gestational age, which underestimates the true burden of stillbirth. With increased registration of early stillbirths in high-income countries, we assessed the reliability of including stillbirths before 28 completed weeks in such comparisons.

Methods

In this population-based study, we used national cohort data from 19 European countries participating in the Euro-Peristat project on livebirths and stillbirths from 22 completed weeks of gestation in 2004, 2010, and 2015. We excluded countries without national data for stillbirths by gestational age in these periods, or where data available were not comparable between 2004 and 2015. We also excluded those countries with fewer than 10 000 births per year because the proportion of stillbirths at 22 weeks to less than 28 weeks of gestation is small. We calculated pooled stillbirth rates using a random-effects model and changes in rates between 2004 and 2015 using risk ratios (RR) by gestational age and country.

Findings

Stillbirths at 22 weeks to less than 28 weeks of gestation accounted for 32% of all stillbirths in 2015. The pooled stillbirth rate at 24 weeks to less than 28 weeks declined from 0·97 to 0·70 per 1000 births from 2004 to 2015, a reduction of 25% (RR 0·75, 95% CI 0·65–0·85). The pooled stillbirth rate at 22 weeks to less than 24 weeks of gestation in 2015 was 0·53 per 1000 births and did not significantly changed over time (RR 0·97, 95% CI 0·80–1·16) although changes varied widely between countries (RRs 0·62–2·09). Wide variation in the percentage of all births occurring at 22 weeks to less than 24 weeks of gestation suggest international differences in ascertainment.

Interpretation

Present definitions used for international comparisons exclude a third of stillbirths. International consistency of reporting stillbirths at 24 weeks to less than 28 weeks suggests these deaths should be included in routinely reported comparisons. This addition would have a major impact, acknowledging the burden of perinatal death to families, and making international assessments more informative for clinical practice and policy. Ascertainment of fetal deaths at 22 weeks to less than 24 weeks should be stabilised so that all stillbirths from 22 completed weeks of gestation onwards can be reliably compared.

Funding

EU Union under the framework of the Health Programme and the Bridge Health Project.

Keywords: Pregnancy; Society; European Region.

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In vitro activity of #ceftazidime / #avibactam against isolates of #Pseudomonas aeruginosa collected in #European countries: INFORM global surveillance 2012–15 (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

In vitro activity of ceftazidime/avibactam against isolates of Pseudomonas aeruginosa collected in European countries: INFORM global surveillance 2012–15

Krystyna M Kazmierczak, Boudewijn L M de Jonge, Gregory G Stone, Daniel F Sahm

Journal of Antimicrobial Chemotherapy, dky267, https://doi.org/10.1093/jac/dky267

Published: 11 July 2018

 

Abstract

Objectives

The activity of ceftazidime/avibactam was assessed against 5716 Pseudomonas aeruginosa isolates collected from 96 medical centres in 18 European countries as part of the International Network for Optimal Resistance Monitoring (INFORM) global surveillance programme from 2012 to 2015. Activity was analysed against subsets of isolates based on resistance phenotypes and β-lactamase content.

Methods

Antimicrobial susceptibility testing was performed by broth microdilution and β-lactamase genes were detected by PCR screening and sequencing.

Results

Ceftazidime/avibactam was highly active in vitro against the overall collection of P. aeruginosa isolates and colistin-resistant isolates (92.4% and 92.9% susceptible, respectively). Although activity was slightly reduced against MBL-negative subsets of ceftazidime-non-susceptible (79.6% susceptible), meropenem-non-susceptible (85.1% susceptible) and MDR (81.6% susceptible) P. aeruginosa, ceftazidime/avibactam remained the second most active entity, after colistin, compared with all other comparator agents tested. At the country level, susceptibility to ceftazidime/avibactam ranged from 74.6% to 99.6%, with decreased susceptibilities only observed in countries where MBLs are more frequently encountered, such as the Czech Republic, Greece, Romania and Russia. Ceftazidime/avibactam was also active in vitro against 87.6% of meropenem-non-susceptible isolates in which no acquired β-lactamases were detected by molecular methods; these isolates were assumed to hyperproduce the chromosomally encoded AmpC in combination with alterations in OprD or drug efflux. As expected, ceftazidime/avibactam was not active against isolates carrying MBLs.

Conclusions

The data show that ceftazidime/avibactam is highly potent in vitro against clinical isolates of P. aeruginosa collected in European countries, including isolates that exhibit resistance to ceftazidime, meropenem and colistin and combined resistance to agents from multiple drug classes.

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Keywords: Antibiotics; Drugs Resistance; Colistin; Meropenem; Avibactam; Ceftazidime; Pseudomonas aeruginosa; European Region.

——

In vitro activity of #ceftazidime / #avibactam against isolates of #Enterobacteriaceae collected in #European countries: #INFORM global surveillance 2012–15 (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

In vitro activity of ceftazidime/avibactam against isolates of Enterobacteriaceae collected in European countries: INFORM global surveillance 2012–15

Krystyna M Kazmierczak, Boudewijn L M de Jonge, Gregory G Stone, Daniel F Sahm

Journal of Antimicrobial Chemotherapy, dky266, https://doi.org/10.1093/jac/dky266

Published: 11 July 2018

 

Abstract

Objectives

The activity of ceftazidime/avibactam was assessed against 24 750 isolates of Enterobacteriaceae collected from 96 medical centres in 18 European countries as part of the International Network for Optimal Resistance Monitoring (INFORM) global surveillance programme from 2012 to 2015. Activity was analysed against subsets of isolates based on resistant phenotypes and β-lactamase content.

Methods

Antimicrobial susceptibility testing was performed using broth microdilution and the presence of β-lactamase genes in isolates of interest was determined using PCR and sequencing.

Results

Ceftazidime/avibactam was the most active agent, compared with all other tested comparator agents, against the overall collection of Enterobacteriaceae isolates (99.4% susceptible) and against subsets of ceftazidime-non-susceptible (97.7% susceptible), colistin-resistant (98.2% susceptible), MDR (96.7% susceptible) and meropenem-non-susceptible, MBL-negative (98.5% susceptible) isolates. At the country level, susceptibility to ceftazidime/avibactam ranged from 96.3% to 100% among Enterobacteriaceae isolates, with decreased susceptibilities only observed in countries where MBLs were more frequently encountered (e.g. Greece and Romania). Ceftazidime/avibactam was active against 99.7% of Enterobacteriaceae isolates that carried serine β-lactamases, including ESBLs, AmpC cephalosporinases and carbapenemases (KPC, GES and OXA-48-like) in all combinations. As expected, ceftazidime/avibactam was not active against isolates carrying MBLs.

Conclusions

The data show that ceftazidime/avibactam is highly potent in vitro against clinical isolates of Enterobacteriaceae collected in European countries, including isolates that exhibit resistance to ceftazidime, meropenem and colistin and combined resistance to agents from multiple drug classes.

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Keywords: Antibiotics; Drugs Resistance; Colistin; Meropenem; Ceftazidime; Avibactam; Enterobacteriaceae; European Region.

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