1887
  1. Home
  2. Eurosurveillance
  3. Volume 24, Issue 46, 14/Nov/2019
  4. Article
Research Open Access
Like 1
Download

Abstract

Background

Healthcare-associated infections (HAIs) pose a major challenge to health systems. Burden of disease estimations in disability-adjusted life years (DALYs) are useful for comparing and ranking HAIs.

Aim

To estimate the number of five common HAIs, their attributable number of deaths and burden for Germany.

Methods

We developed a new method and R package that builds on the approach used by the Burden of Communicable Diseases in Europe (BCoDE) project to estimate the burden of HAIs for individual countries. We used data on healthcare-associated infection, healthcare-associated pneumonia, healthcare-associated primary bloodstream infection, healthcare-associated urinary tract infection and surgical-site infection, which were collected during the point prevalence survey of HAIs in European acute-care hospitals between 2011 and 2012.

Results

We estimated 478,222 (95% uncertainty interval (UI): 421,350–537,787) cases for Germany, resulting in 16,245 (95% UI: 10,863–22,756) attributable deaths and 248,920 (95% UI: 178,693–336,239) DALYs. Despite the fact that Germany has a relatively low hospital prevalence of HAIs compared with the European Union/European Economic Area (EU/EEA) average, the burden of HAIs in Germany (308.2 DALYs/100,000 population; 95% UI: 221.2–416.3) was higher than the EU/EEA average (290.0 DALYs/100,000 population; 95% UI: 214.9–376.9). Our methodology is applicable to other countries in or outside of the EU/EEA. An R package is available from https://CRAN.R-project.org/package=BHAI.

Conclusion

This is the first study to estimate the burden of HAIs in DALYs for Germany. The large number of hospital beds may be a contributing factor for a relatively high burden of HAIs in Germany. Further focus on infection prevention control, paired with reduction of avoidable hospital stays, is needed to reduce the burden of HAIs in Germany.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2019.24.46.1900135
2019-11-14
2024-12-31
/content/10.2807/1560-7917.ES.2019.24.46.1900135
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/24/46/eurosurv-24-46-4.html?itemId=/content/10.2807/1560-7917.ES.2019.24.46.1900135&mimeType=html&fmt=ahah

References

  1. Gastmeier P, Brunkhorst F, Schrappe M, Kern W, Geffers C. [How many nosocomial infections are avoidable?]. Dtsch Med Wochenschr. 2010;135(3):91-3.  https://doi.org/10.1055/s-0029-1244823  PMID: 20077383 
  2. Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, et al. , systematic review and evidence-based guidance on organization of hospital infection control programmes (SIGHT) study group. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. Lancet Infect Dis. 2015;15(2):212-24.  https://doi.org/10.1016/S1473-3099(14)70854-0  PMID: 25467650 
  3. Cassini A, Plachouras D, Eckmanns T, Abu Sin M, Blank HP, Ducomble T, et al. Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study. PLoS Med. 2016;13(10):e1002150.  https://doi.org/10.1371/journal.pmed.1002150  PMID: 27755545 
  4. Kretzschmar M, Mangen MJ, Pinheiro P, Jahn B, Fèvre EM, Longhi S, et al. , BCoDE consortium. New methodology for estimating the burden of infectious diseases in Europe. PLoS Med. 2012;9(4):e1001205.  https://doi.org/10.1371/journal.pmed.1001205  PMID: 22529750 
  5. Mangen MJ, Plass D, Havelaar AH, Gibbons CL, Cassini A, Mühlberger N, et al. , BCoDE consortium. The pathogen- and incidence-based DALY approach: an appropriate [corrected] methodology for estimating the burden of infectious diseases. PLoS One. 2013;8(11):e79740.  https://doi.org/10.1371/journal.pone.0079740  PMID: 24278167 
  6. European Centre for Disease Control and Prevention (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2013.
  7. Colzani E, Cassini A, Lewandowski D, Mangen MJ, Plass D, McDonald SA, et al. A Software Tool for Estimation of Burden of Infectious Diseases in Europe Using Incidence-Based Disability Adjusted Life Years. PLoS One. 2017;12(1):e0170662.  https://doi.org/10.1371/journal.pone.0170662  PMID: 28107447 
  8. European Centre for Disease Control and Prevention (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals - protocol version 4.3. Stockholm: ECDC; 2012.
  9. Abu Sin M, Blank HP, Ducomble T, Eckmanns T, Haller S, Harder T, et al. Burden of healthcare associated infection (BHAI)—evidence-based and comorbidity-adjusted outcome trees for estimation of burden of disease. Berlin: Robert Koch-Institut; 2016.
  10. Haller S, Deindl P, Cassini A, Suetens C, Zingg W, Abu Sin M, et al. Neurological sequelae of healthcare-associated sepsis in very-low-birthweight infants: Umbrella review and evidence-based outcome tree. Euro Surveill. 2016;21(8):30143.  https://doi.org/10.2807/1560-7917.ES.2016.21.8.30143  PMID: 26940884 
  11. Haagsma JA, Maertens de Noordhout C, Polinder S, Vos T, Havelaar AH, Cassini A, et al. Assessing disability weights based on the responses of 30,660 people from four European countries. Popul Health Metr. 2015;13(1):10.  https://doi.org/10.1186/s12963-015-0042-4  PMID: 26778920 
  12. Rhame FS, Sudderth WD. Incidence and prevalence as used in the analysis of the occurrence of nosocomial infections. Am J Epidemiol. 1981;113(1):1-11.  https://doi.org/10.1093/oxfordjournals.aje.a113058  PMID: 7457475 
  13. Eurostat - Hospital discharges and length of stay for inpatient and curative care. Available from: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_co_dischls&lang=en
  14. Willrich N, Haller S, Eckmanns T, Zacher B, Kärki T, Plachouras D, et al. From prevalence to incidence - a new approach in the nosocomial setting. bioRxiv. 2019:554725.
  15. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. , The Healthcare-Associated Infections Prevalence Study Group. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46):1800516.  https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800516  PMID: 30458912 
  16. Plass D, Mangen MJ, Kraemer A, Pinheiro P, Gilsdorf A, Krause G, et al. The disease burden of hepatitis B, influenza, measles and salmonellosis in Germany: first results of the burden of communicable diseases in Europe study. Epidemiol Infect. 2014;142(10):2024-35.  https://doi.org/10.1017/S0950268813003312  PMID: 24480146 
  17. Rüden HDF, Schumacher M. Nosokomiale Infektionen in Deutschland - Erfassung und Prävention (NIDEP-Studie). [Nosocomial infections in Germany - detection and prevention (NIDEP study)]. In: Gesundheit BdSdBf, 1st edition. Baden-Baden: Nomos Verlagsgesellschaft; 1995. German.
  18. Gastmeier P, Geffers C. [Nosocomial infections in Germany. What are the numbers, based on the estimates for 2006?]. Dtsch Med Wochenschr. 2008;133(21):1111-5.  https://doi.org/10.1055/s-2008-1077224  PMID: 18478503 
  19. Cassini A, Colzani E, Pini A, Mangen MJ, Plass D, McDonald SA, et al. , On Behalf Of The BCoDE Consortium. Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013. Euro Surveill. 2018;23(16):1700454.  https://doi.org/10.2807/1560-7917.ES.2018.23.16.17-00454  PMID: 29692315 
  20. Murray CJ, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C, et al. GBD 2010: a multi-investigator collaboration for global comparative descriptive epidemiology. Lancet. 2012;380(9859):2055-8.  https://doi.org/10.1016/S0140-6736(12)62134-5  PMID: 23245598 
  21. Plass D, Vos T, Hornberg C, Scheidt-Nave C, Zeeb H, Krämer A. Trends in disease burden in Germany: results, implications and limitations of the Global Burden of Disease study. Dtsch Arztebl Int. 2014;111(38):629-38. PMID: 25316518 
  22. Eurostat - Number of hospital beds (curative care). Available from: http://ec.europa.eu/eurostat/tgm/table.do?tab=table&init=1&language=de&pcode=tps00168&plugin=1
  23. Kumar A, Schoenstein M. Managing Hospital Volumes: Germany and Experiences from OECD Countries. Paris: Organization for Economic Cooperation and Development (OECD); 2013.
  24. Rhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz PG, Moreno RP. The variability of critical care bed numbers in Europe. Intensive Care Med. 2012;38(10):1647-53.  https://doi.org/10.1007/s00134-012-2627-8  PMID: 22777516 
  25. Deutsche nationale Punkt-Prävalenzerhebung zu nosokomialen Infektionen und Antibiotika-Anwendung 2016. [German national point prevalence survey on nosocomial infections and antibiotic use 2016]. Nationalen Referenzzentrums für Surveillance von nosokomialen Infektionen; 2017. German. Available from: https://www.nrz-hygiene.de/fileadmin/nrz/download/pps2016/PPS_2016_Abschlussbericht_20.07.2017.pdf
  26. KRINKO. Prävention und Kontrolle Katheter-assoziierter Harnwegsinfektionen: Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015;58(6):641-50.  https://doi.org/10.1007/s00103-015-2152-3  PMID: 25824136 
  27. Behnke M, Aghdassi SJ, Hansen S, Diaz LAP, Gastmeier P, Piening B. The Prevalence of Nosocomial Infection and Antibiotic Use in German Hospitals. Dtsch Arztebl Int. 2017;114(50):851-7.  https://doi.org/10.3238/arztebl.2017.0851  PMID: 29271343 
  28. Busse R, Ganten D, Huster S, Reinhardt ER, Suttorp N, Wiesing U. Zum Verhältnis von Medizin und Ökonomie im deutschen Gesundheitssystem. [On the relationship between medicine and economics in the German health system]. Halle (Saale): Deutsche Akademie der Naturforscher Leopoldina e.V.; 2016. German
Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Benedikt+Zacher&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zacher Benedikt</a>, <a href="/search?value1=Sebastian+Haller&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haller Sebastian</a>, <a href="/search?value1=Niklas+Willrich&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Willrich Niklas</a>, <a href="/search?value1=Jan+Walter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Walter Jan</a>, <a href="/search?value1=Muna+Abu+Sin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Abu Sin Muna</a>, <a href="/search?value1=Alessandro+Cassini&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cassini Alessandro</a>, <a href="/search?value1=Diamantis+Plachouras&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Plachouras Diamantis</a>, <a href="/search?value1=Carl+Suetens&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Suetens Carl</a>, <a href="/search?value1=Michael+Behnke&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Behnke Michael</a>, <a href="/search?value1=Petra+Gastmeier&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gastmeier Petra</a>, <a href="/search?value1=Lothar+H.+Wieler&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wieler Lothar H.</a>, <a href="/search?value1=Tim+Eckmanns&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Eckmanns Tim</a></span>. Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(46):pii=1900135. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.46.1900135" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.46.1900135</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 19 Feb 2019;&nbsp;&nbsp; <span class="generated">Accepted</span>: 12 Sept 2019 </span> </p>
/content/10.2807/1560-7917.ES.2019.24.46.1900135
/content/10.2807/1560-7917.ES.2019.24.46.1900135
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error