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

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6-2

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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