@article{3183351,
    title = "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",
    author = "Cassini, Alessandro and Hogberg, Liselotte Diaz and Plachouras, and Diamantis and Quattrocchi, Annalisa and Hoxha, Ana and Simonsen, Gunnar and Skov and Colomb-Cotinat, Melanie and Kretzschmar, Mirjam E. and and Devleesschauwer, Brecht and Cecchini, Michele and Ouakrim, Driss Ait and and Oliveira, Tiago Cravo and Struelens, Marc J. and Suetens, Carl and and Monnet, Dominique L. and Strauss, Reinhild and Mertens, Karl and Struyf, and Thomas and Catry, Boudewijn and Latour, Katrien and Ivanov, Ivan and Nikolaev and Dobreva, Elina Georgieva and Tambic Andrasevic, Arjana and and Soprek, Silvija and Budimir, Ana and Paphitou, Niki and Zemlickova, and Helena and Olsen, Stefan Schytte and Sonksen, Ute Wolff and Martin, and Pille and Ivanova, Marina and Lyytikainen, Outi and Jalava, Jari and and Coignard, Bruno and Eckmanns, Tim and Abu Sin, Muna and Haller, and Sebastian and Daikos, George L. and Gikas, Achilleas and Tsiodras, and Sotirios and Kontopidou, Flora and Toth, Akos and Hajdu, Agnes and and Guolaugsson, Olafur and Kristinsson, Karl G. and Murchan, Stephen and and Burns, Karen and Dsstat, Patrizio Pezzotti and Gagliotti, Carlo and and Dumpis, Uga and Liuimiene, Agne and Perrin, Monique and Borg, Michael A. and and de Greeff, Sabine C. and Monen, Jos C. M. and Koek, Mayke B. G. and and Elstrom, Petter and Zabicka, Dorota and Deptula, Aleksander and and Hryniewicz, Waleria and Canica, Manuela and Nogueira, Paulo Jorge and and Fernandes, Paulo Andre and Manageiro, Vera and Popescu, Gabriel Adrian and and Serban, Roxana Ioana and Schreterova, Eva and Litvova, Slavka and and Stefkovicova, Maria and Kolman, Jana and Klavs, Irena and Korosec, Ales and and Aracil, Belen and Asensio, Angel and Perez-Vazquez, Maria and and Billstrom, Hanna and Larsson, Sofie and Reilly, Jacqui S. and Johnson, and Alan and Hopkins, Susan and Burden Amr Collaborative Grp",
    journal = "The Lancet Infectious Diseases",
    year = "2019",
    volume = "19",
    number = "1",
    pages = "56-66",
    publisher = "Elsevier Sci Ltd, Exeter, United Kingdom",
    doi = "10.1016/S1473-3099(18)30605-4",
    abstract = "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.
Copyright (c) 2018 The Author(s). Published by Elsevier Ltd. This is an
Open Access article under the CC BY 4.0 license."
}