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Surveillance de l’antibiorésistance et des consommations d’antibiotiques: perspective européenne at place de la France
European Centre for Disease Prevention and Control
Dominique L. Monnet, for the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Programme, ECDC
Colloque Interministériel Antibiorésistance, Paris, 20 November 2018
Burden of infections with antibiotic-resistant bacteria is comparable to burden of influenza, TB & HIV/AIDS combined
Adapted from: Cassini A, et al. Eurosurveillance 2018;23(16):pii=17-00454; Cassini A, et al. Lancet Infectious Diseases. 5 November 2018.
671 689 infections with antibiotic-resistant bacteria, 63% were healthcare-associated infections
33 110 attributable deaths
170 DALYs* per 100 000 population,
• 75% due to healthcare-associated infections
• 70% due to 4 top-ranking antibiotic-resistant bacteria
• 39% due to carbapenem- and/or colistin resistance
Dis
abili
ty-a
dju
sted life y
ears
(D
ALY
s) p
er
100,0
00 p
opula
tion
Estimated burden of infections with antibiotic-resistant bacteria, age-group standardised, EU/EEA, 2015
Source: Cassini A, et al. Lancet Infectious Diseases. 5 November 2018.
Disability-adjusted life years (DALYs) per 100,000 population
4
https://www.ecdc.europa.eu/en/antimicrobial-resistancehttps://www.eurosurveillance.org/
Community
Consumption of antibacterials for systemic use (ATC group J01) in the community, EU/EEA, 2009-2018
Defined daily doses (DDDs) per 1000 inhabitants per day
Source: ESAC-Net, ECDC, 2019.
All country data are shown as they are reported to the European Surveillance System at ECDC.* These countries only reported data for the community and the hospital sector combined.N/A, not applicable. Spain reported 2009-2015 reimbursement data and changed in 2016 to sales data.†Cyprus: 2017 data. Czech Republic: 2015 data.
EU/EEA refers to the corresponding population-weighted mean consumption based on reported antimicrobial consumption data of all 30 EU/EEA countries. Through imputation and other adjustments, the EU/EEA averages include the same number of EU/EEA countries for all years of the trend analyses.
28.9*†
17.4†
Ratio consumption of “broad-spectrum” / “narrow-spectrum” antibiotics* in the community, EU/EEA, 2009-2018
*Ratio consumption of “broad-spectrum” penicillins, “broad-spectrum” cephalosporins, macrolides (except erythromycin) and fluoroquinolones / consumption of “narrow-spectrum” penicillins, “narrow-spectrum” cephalosporins and erythromycin (consumption expressed as DDD per 1 000 inhabitants per day)
[(J01CR+J01DC+J01DD+(J01FA–J01FA01)+J01MA)]
/ [(J01C–J01CR)+J01DB+J01FA01)]
Source: ESAC-Net, ECDC, 2019.
All country data are shown as they are reported to the European Surveillance System at ECDC.* These countries only reported data for the community and the hospital sector combined.N/A, not applicable. Spain reported 2009-2015 reimbursement data and changed in 2016 to sales data.†Cyprus: 2017 data. Czech Republic: 2015 data.
EU/EEA refers to the corresponding population-weighted mean consumption based on reported antimicrobial consumption data of all 30 EU/EEA countries. Through imputation and other adjustments, the EU/EEA averages include the same number of EU/EEA countries for all years of the trend analyses.
8.8*†
3.0†
Streptococcus pneumoniae: % of invasive isolates with resistance to macrolides, EU/EEA, 2018
Source: EARS-Net, ECDC, 2019.
The symbols and indicate a significant increasing or decreasing trend for the period 2015-2018, respectively. These trends were calculated on laboratories that consistently reported during this period.
Escherichia coli: % of invasive isolates with resistanceto third-generation cephalosporins, EU/EEA, 2018
Source: EARS-Net, ECDC, 2019.
The symbols and indicate a significant increasing or decreasing trend for the period 2015-2018, respectively. These trends were calculated on laboratories that consistently reported during this period.
Photo: Luis García
Hospitals
Prevalence of antimicrobial use in acute care hospitals, EU/EEA and Serbia, 2016-2017
Source: Plachouras D, et al. Eurosurveillance 15 November 2018
* Bulgaria, the Netherlands: poor national representativeness of acute care hospital sample; ** Norway: national protocol.
1 in 3 patients
in acute care hospitalsin EU/EEA countries
received
at least one antimicrobial
on any given day
Surgical antibiotic prophylaxis in acute care hospitals, by duration (single dose, one day, more than one day), EU/EEA countries and Serbia, 2016-2017
54% surgical antibiotic prophylaxis
courses in EU/EEA countrieswere prescribed for
more than one day
1 dose
1 day
more than 1 day
Source: Plachouras D, et al. Eurosurveillance 15 November 2018.
Source: Plachouras D, et al. Eurosurveillance 15 November 2018.
Proportion of “broad-spectrum” antibiotics* in acute care hospitals, EU/EEA countries & Serbia, 2016–2017
Proportion of “broad-spectrum” antibiotics (%)
*
Staphylococcus aureus: % of invasive isolates with resistance to meticillin (MRSA), EU/EEA, 2018
Source: EARS-Net, ECDC, 2019. 14
The symbols and indicate a significant increasing or decreasing trend for the period 2015-2018, respectively. These trends were calculated on laboratories that consistently reported during this period.
Enterococcus faecium: % of invasive isolates with resistance to vancomycin, EU/EEA, 2018
Source: EARS-Net, ECDC, 2019.
The symbols and indicate a significant increasing or decreasing trend for the period 2015-2018, respectively. These trends were calculated on laboratories that consistently reported during this period.
Klebsiella pneumoniae: % of invasive isolates with combined resistance*, EU/EEA, 2018
Source: EARS-Net, ECDC, 2019.
The symbols and indicate a significant increasing or decreasing trend for the period 2015-2018, respectively. These trends were calculated on laboratories that consistently reported during this period.
*Resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides
Klebsiella pneumoniae: % of invasive isolates with resistance to carbapenems, EU/EEA, 2018
Source: EARS-Net, ECDC, 2019.
The symbols and indicate a significant increasing or decreasing trend for the period 2015-2018, respectively. These trends were calculated on laboratories that consistently reported during this period.
Source: Peñalva G, et al.; EARS-Net; ESAC-Net. Eurosurveillance 14 November 2019. 18
Trends in antimicrobial consumption and antimicrobial resistance, population-weighted means, EU/EEA, 2001-2018
Third-generation cephalosporins Fluoroquinolones Carbapenems
Re
sis
tan
ce
Co
nsu
mp
tio
n(%
iso
late
s) (
DD
D p
er
1,0
00 inh. per
day)
Hospital sector
Hospital sector Hospital sector
Community Community
K. pneumoniae K. pneumoniae K. pneumoniae
E. coliE. coli
Composite index* of antimicrobial resistance (AMR) in healthcare-associated infections from acute care hospitals, EU/EEA countries and Serbia, 2016-2017
*Percentage of isolates resistant to first-level antimicrobial resistance markers in healthcare-associated infections, i.e.:- Staphylococcus aureus resistant to meticillin (MRSA), - Enterococcus faecium and Enterococcus faecalis resistant
to vancomycin, - Enterobacteriaceae resistant to third-generation
cephalosporins, - Pseudomonas aeruginosa and Acinetobacter baumannii
resistant to carbapenems.
Adapted from: Suetens C, et al. Eurosurveillance 15 November 2018.
* Bulgaria and the Netherlands: poor national representativeness of acute care hospital sample; ** Norway: national protocol; Norway and UK-Scotland did not collect microbiological data..
Correlations between composite indices of antimicrobial resistance (AMR) from ECDC data
Adapted from: Suetens C, et al. Eurosurveillance 15 November 2018.
PPS long-term care facilities 2016-2017EARS-Net 2016
PP
S a
cu
te c
are
ho
sp
ita
ls 2
01
6-2
01
7
PP
S a
cu
te c
are
ho
sp
ita
ls 2
01
6-2
01
7
Countries with a higher prevalence of antibiotic use have a higher composite index of AMR, but countries with more frequent review and change of antibiotic prescriptions have a lower composite index of AMR
r = 0.51p = 0.004
Source: ECDC point prevalence survey of HAIs and antimicrobial use in European acute care hospitals, 2016-2017 (preliminary, unpublished results).
*Antibacterials for systemic use (ATC J01)
Preliminary results
Preliminary results
r = –0.67p = 0.0001
Patients with at least one antibiotic* (%) Antibiotic* prescriptions reviewedand changed during treatment (%)
Core component 6. monitoring of practices:Alcohol hand rub consumption (L/1000 patient-days)
Source: ECDC PPSs in European acute care hospitals, 2011-2012 & 2016-2017 (preliminary, unpublished results). 22
2011-2012
*poor country representativeness
2016-2017
**
*
*
Liechtenstein
Luxembourg
Malta
Non-visible countries
<10
10-19.9
20-29.9
30-39.9
>=40
No data
Not included
Alcohol hand rubconsumption(L/1000 patient days)
Countries with more resources for infection prevention and control have a lower composite index of AMR
02
04
06
08
0
Co
mp
osite
ind
ex o
f A
MR
(% o
f re
sis
tant is
ola
tes)
0 20 40 60 80 100
Beds with alcohol hand rub dispenser at point of care (%)
02
04
06
08
0
Co
mp
osite
ind
ex o
f A
MR
(% o
f re
sis
tant is
ola
tes)
0 20 40 60
Mean percentage of beds in single rooms
Source: Source: ECDC point prevalence survey of HAIs and antimicrobial use in European acute care hospitals, 2016-2017 (preliminary, unpublished results).
r = –0.57p = 0.003
r = –0.58p = 0.004
Beds with alcohol hand rub dispenser at point of care (%) Beds in single rooms (mean %)
Preliminary results
Preliminary results
France did not report data on this indicator.
Additional preliminary result: Hospitals with at least 0.4 FTE infection prevention and control nurse for 250 beds (r = –0.35, p = 0.04)
24
-16
-12
-8
-4
0
4
8
USD
per
capita p
er
year
Implementation cost
Impact on healthcare expenditure
Economic assessment* of a ‘mixed-intervention’ package†
Just a few dollars more lead to substantial savings in healthcare expenditure
†’Mixed-intervention’ package:
• Improve hospital hygiene(starting with hand hygiene)
• Antimicrobial stewardship
• Rapid diagnostic tests(bacterial vs. viral infection)
• Delayed prescription
• Public awareness campaigns
*Including effect on susceptible infections.
In France, €1 spent on these interventions would save €7.2
Source: OECD. Stemming the Superbug Tide: just a few dollars more. 2018. oe.cd/amr-2018OECD & ECDC. http://www.oecd.org/health/health-systems/AMR-Tackling-the-Burden-in-the-EU-OECD-ECDC-Briefing-Note-2019.pdf
https://antibiotic.ecdc.europa.eu
26
18 November 2019
18-24 NOVEMBER 2019