33,100 deaths in EU/EEA during 2015 attributable to resistant bacteria

Dear All: Cassini et al. have just published a truly scary paper. Here’s the bulk of the abstract … I can’t improve on it.

  • 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.

Here are some ways to put this into context:

  • My math: 33,100 deaths/year = one jumbo jet crash about every 5 days (assumes 400-500 seats/plane)
  • Consistency check #1: In 2009, the European CDC estimated 25,000 deaths/year in the EU due to resistant bacteria
  • Consistency check #2: In 2013, the US CDC estimated 23,000 deaths/year in the US due to resistant bacteria 
  • From Cassini’s discussion: Our finding of 170 DALYs per 100 000 population is similar to the combined burden of three major infectious diseases (influenza, tuberculosis, and HIV), which was 183 DALYs per 100 000 population.
  • From the accompanying editorial by Tacconelli and Pezzani: The DALY burden has doubled since 2007 and is highest in infants (aged <1 year) and older people (aged ≥65 years), and for infections caused by colistin-resistant or carbapenem-resistant bacteria.

It’s time for action! A concrete step would be to get busy during the upcoming (12-18 Nov 2018) WHO (and US CDC) Antibiotic Awareness Week! See the WHO and CDC links for ideas, fact sheets, and graphical materials. It’s only by driving awareness that we drive change.

Frustratedly yours, –jr

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Expert-in-Residence, Wellcome Trust. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future:

Upcoming meetings of interest to the AMR community:

  • 12-18 Nov 2018 (everywhere): WHO (and US CDC) Antibiotic Awareness Week. Events now being planned … see the WHO and CDC links for ideas, fact sheets, and graphical materials.
  • 12-13 Nov 2018 (London): Joint SCI– and Royal Society of Chemistry-sponsored 2nd annual Symposium on Antimicrobial Discovery. Online materials here.
  • 13 Nov 2018 (London): All-Parties Parliamentary Working Group on AMR meeting. Online materials here
  • [NEW] 13 Nov 2018 (online): REVIVE Webinar: “Making safety part of drug design.” This is a follow-on to the Sep 2018 CARB-X – GARDP bootcamp on safety (access those videos here).
  • 15-17 Nov 2018 (Santiago de Cali, Columbia): 16th Infocus Forum on Fungal Infection in Clinical Practice. Online materials here.
  • 16 Nov 2018 (Berlin): Max Planck Institute for Innovation and Competition is organizing a conference on life sciences and innovation. Online materials here.
  • 19-20 Nov 2018 (Accra, Ghana): Call to Action on Antimicrobial Resistance. Latest agenda here. To attend, contact AMRCalltoAction@wellcome.ac.uk.
  • 21 Nov 2018 (London): NICE- & APBI-sponsored masterclass: “Using non-randomised data to estimate treatment effects in NICE submissions”. Details here.
  • 29-30 Nov 2018 (Birmingham, UK): BSAC (British Society Antimicrobial Chemotherapy): Antibiotic Resistance Mechanisms Workshop for Researchers
  • 7 Dec 2018 (Boston, MA): BAARN, Boston Area Antimicrobial Resistance Network 2018 symposium, 8:30am to 7pm at The Starr Center (185 Cambridge Street, Boston, MA). This is an excellent networking opportunity, especially for those based in the Boston area. Register here.
  • 15 Jan 2018 (London): BSAC’s Antimicrobial Chemotherapy Conference 2019: “An ABC for everyone involved in developing new antimicrobials.” Details here.
  • 14-15 Mar 2019 (Berlin): BEAM– and ND4BB-ENABLE-sponsored Berlin Conference on Novel Antimicrobials and AMR Diagnostics. Details here.
  • 21-22 Mar 2019 (Birmingham, UK): BSAC Spring Conference.


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