Date Published: October 18, 2016
Publisher: Public Library of Science
Author(s): Alessandro Cassini, Diamantis Plachouras, Tim Eckmanns, Muna Abu Sin, Hans-Peter Blank, Tanja Ducomble, Sebastian Haller, Thomas Harder, Anja Klingeberg, Madlen Sixtensson, Edward Velasco, Bettina Weiß, Piotr Kramarz, Dominique L. Monnet, Mirjam E. Kretzschmar, Carl Suetens, Stephan Harbarth
Abstract: BackgroundEstimating the burden of healthcare-associated infections (HAIs) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. Based on the methodology of the Burden of Communicable Diseases in Europe (BCoDE) project and 2011–2012 data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals, we estimated the burden of six common HAIs.Methods and FindingsThe included HAIs were healthcare-associated pneumonia (HAP), healthcare-associated urinary tract infection (HA UTI), surgical site infection (SSI), healthcare-associated Clostridium difficile infection (HA CDI), healthcare-associated neonatal sepsis, and healthcare-associated primary bloodstream infection (HA primary BSI). The burden of these HAIs was measured in disability-adjusted life years (DALYs). Evidence relating to the disease progression pathway of each type of HAI was collected through systematic literature reviews, in order to estimate the risks attributable to HAIs. For each of the six HAIs, gender and age group prevalence from the ECDC PPS was converted into incidence rates by applying the Rhame and Sudderth formula. We adjusted for reduced life expectancy within the hospital population using three severity groups based on McCabe score data from the ECDC PPS. We estimated that 2,609,911 new cases of HAI occur every year in the European Union and European Economic Area (EU/EEA). The cumulative burden of the six HAIs was estimated at 501 DALYs per 100,000 general population each year in EU/EEA. HAP and HA primary BSI were associated with the highest burden and represented more than 60% of the total burden, with 169 and 145 DALYs per 100,000 total population, respectively. HA UTI, SSI, HA CDI, and HA primary BSI ranked as the third to sixth syndromes in terms of burden of disease. HAP and HA primary BSI were associated with the highest burden because of their high severity. The cumulative burden of the six HAIs was higher than the total burden of all other 32 communicable diseases included in the BCoDE 2009–2013 study. The main limitations of the study are the variability in the parameter estimates, in particular the disease models’ case fatalities, and the use of the Rhame and Sudderth formula for estimating incident number of cases from prevalence data.ConclusionsWe estimated the EU/EEA burden of HAIs in DALYs in 2011–2012 using a transparent and evidence-based approach that allows for combining estimates of morbidity and of mortality in order to compare with other diseases and to inform a comprehensive ranking suitable for prioritization. Our results highlight the high burden of HAIs and the need for increased efforts for their prevention and control. Furthermore, our model should allow for estimations of the potential benefit of preventive measures on the burden of HAIs in the EU/EEA.
Partial Text: Healthcare-associated infections (HAIs) are associated with increased morbidity and mortality and excess costs, and because a significant proportion of them are preventable, they are considered to be a marker of quality of patient care . Many studies have attempted to estimate the number of cases of HAIs and of deaths attributable to these infections [2–6]. Such studies have used descriptive methods, modelling approaches, or a combination of the two.
Based on data from 2011–2012, we estimated that 2,609,911 (95% UI: 2,451,235–2,778,451) new cases of HAI occur every year in the EU/EEA. These HAIs accounted for a total of 2,506,091 DALYs (95% UI: 2,163,850–2,877,574) annually in the EU/EEA, corresponding to 501 DALYs per 100,000 general population (95% UI: 429–582). These DALYs consisted of 2 million YLLs (75% of total DALYs) and 681,400 YLDs.
To our knowledge, this study represents the first attempt to estimate the burden of HAIs expressed in DALYs. Estimation of the burden of disease expressed in DALYs is a comprehensive and evidence-based approach to evaluate the burden of a disease that can be used to inform policy making in public health. The DALY is a composite measure that accounts not only for the number of cases but also for the associated mortality and short-term and long-term disabilities that result from a disease. DALYs provide a more comprehensive view of the burden of a disease, and the ranking of diseases according to DALYs is often different from the ranking based on incidence (Fig 5).