Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study
Top Cited Papers
Open Access
- 18 October 2016
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLoS Medicine
- Vol. 13 (10), e1002150
- https://doi.org/10.1371/journal.pmed.1002150
Abstract
Estimating 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. The 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. We 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.Keywords
This publication has 27 references indexed in Scilit:
- The Pathogen- and Incidence-Based DALY Approach: An Appropriated Methodology for Estimating the Burden of Infectious DiseasesPLOS ONE, 2013
- The Impact of Infection on Population Health: Results of the Ontario Burden of Infectious Diseases StudyPLOS ONE, 2012
- New Methodology for Estimating the Burden of Infectious Diseases in EuropePLoS Medicine, 2012
- Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and CostsInfection Control & Hospital Epidemiology, 2011
- Conversion of Prevalence Survey Data on Nosocomial Infections to Incidence Estimates: A Simplified Tool for Surveillance?Infection Control & Hospital Epidemiology, 2007
- Administrative Data Fail to Accurately Identify Cases of Healthcare-Associated InfectionInfection Control & Hospital Epidemiology, 2006
- Behavior of Cross-Sectional Surveys in the Hospital Setting: A Simulation ModelInfection Control & Hospital Epidemiology, 2005
- Clostridium difficile–Associated Diarrhea: Epidemiological Data from Western Australia Associated with a Modified Antibiotic PolicyClinical Infectious Diseases, 2002
- Morbidity and mortality associated withsurgical site infections: results from the 1997–1999 INCISO surveillanceJournal of Hospital Infection, 2001
- Converting Incidence and Prevalence Data of Nosocomial Infections Results From Eight HospitalsInfection Control & Hospital Epidemiology, 2001