Background
Methods
Microorganisms selected
-
being associated with invasive infections, i.e., infections with a bacteria isolated from blood or cerebrospinal fluid [5];
-
having a significant prevalence or having emerged recently;
-
being included in a surveillance network in France;
-
being multidrug-resistant (MDR) as defined in the European Antimicrobial Resistance Surveillance Network (EARS-Net) protocol [5].
-
Staphylococcus aureus resistant to methicillin (MRSA);
-
Enterococcus faecium and E. faecalis resistant to glycopeptides (GRE);
-
Escherichia coli resistant to third-generation cephalosporins (3GC-R E. Coli);
-
Klebsiella pneumoniae resistant to third-generation cephalosporins (3GC-R K. pneumoniae);
-
Pseudomonas aeruginosa resistant to carbapenems (CR P. aeruginosa);
-
Klebsiella pneumoniae resistant to carbapenems (CR K. pneumoniae);
-
Acinetobacter spp. resistant to carbapenems (CR Acinetobacter spp).
Number of infections due to MDRB
-
for all MDRB: invasive infections (bacteria isolated from blood or cerebrospinal fluid), urinary tract infections, skin and soft tissue infections, and surgical site infections;
-
for all MDRB excluding GRE: respiratory tract infections;
-
for MRSA only: bone and joint infections (does not include surgical site infections);
-
for GRE only: gastrointestinal tract infections (gastro-intestinal and intra-abdominal infections).
Body sites | PPS ratio | Ratios from the literature | |
---|---|---|---|
Low value | High value | ||
No. MRSA urinary tract infections/No. MRSA invasive infections | 0.98 [7] | 0.75 [11] | 2.30 [12] |
No. MRSA respiratory infections/No. MRSA invasive infections | 2.37 [7] | 1.25 [11] | 2.50 [12] |
No. MRSA skin and soft tissue infections and surgical site infections/No. MRSA invasive infections | 4.17 [7] | 4.90 [12] | 5.25 [11] |
No. MRSA bone and joint infections/No. MRSA invasive infections | 0.79 [7] |
b
| 1.38 [12] |
No. GRE urinary tract infections/No. GRE invasive infections | 4.33 [7] | 2.33 [13] | 3.44 [14] |
No. GRE gastrointestinal tract infections /No. GRE invasive infections | 2.65 [7] | 1.89 [14] |
b
|
No. GRE skin and soft tissue infections and surgical site infections/No. GRE invasive infections | 1.46 [7] | 4.67 [14] | 5.00 [13] |
No. 3GC-R E. coli urinary tract infections/No. 3GC-R E. coli invasive infections | 5.50 [7] | 2.30 [13] |
b
|
No. 3GC-R E. coli respiratory tract infections/No. 3GC-R E. coli invasive infections | 1.08 [7] |
b
| 2.50 [13] |
No. 3GC-R E. coli skin and soft tissue infections and surgical site infections/No. 3GC-R E. coli invasive infections | 1.37 [7] |
b
| 4.90 [13] |
No. 3GC-R K. pneumoniae urinary tract infections/No. 3GC-R K. pneumoniae invasive infections | 2.90 [7] | 1.19 [15] | 2.30 [13] |
No. 3GC-R K. pneumoniae respiratory tract infections/No. 3GC-R K. pneumoniae invasive infections | 2.55 [7] | 1.19 [15] | 2.50 [13] |
No. 3GC-R K. pneumoniae skin and soft tissue infections and surgical site infections/No. 3GC-R K. pneumoniae invasive infections | 0.82 [7] | 0.33 [15] | 4.90 [13] |
No. CR K. pneumoniae urinary tract infections/No. CR K. pneumoniae invasive infections | 2.71 [7] | 3.00 [16] | 3.10 [17] |
No. CR K. pneumoniae respiratory tract infections/No. CR K. pneumoniae invasive infections | 3.10 [7] | 0.42 [17] | 1.60 [16] |
No. CR K. pneumoniae skin and soft tissue infections and surgical site infections/No. CR K. pneumoniae invasive infections | 0.44a
| 0.28 [17] | 0.60 [16] |
No. CR P. aeruginosa urinary tract infections/No. CR P. aeruginosa invasive infections | 2.11 [7] |
b
| 11.30 [15] |
No. CR P. aeruginosa respiratory tract infections/No. CR P. aeruginosa invasive infections | 10.99 [7] |
b
| 16.00 [15] |
No. CR P. aeruginosa skin and soft tissue infections and surgical site infections/No. CR P. aeruginosa invasive infections | 3.07 [7] |
b
| 4.67 [15] |
No. CR Acinetobacter urinary tract infections/No. CR Acinetobacter invasive infections | 0.58a
| 0.32 [18] | 0.83 [17] |
No. CR Acinetobacter respiratory tract infections/No. CR Acinetobacter invasive infections | 4.64 [7] | 1.21 [18] | 3.83 [17] |
No. CR Acinetobacter skin and soft tissue infections and surgical site infections/No. CR Acinetobacter invasive infections | 0.73a
| 0.29 [18] | 1.17 [17] |
Number of deaths associated with infections due to MDRB
Body sites | Associated deaths (%) | Reference | Year of publication |
---|---|---|---|
MRSA invasive infections | 9.8 | [19] | 2003 |
MRSA urinary tract infections | 0.2 | 1998 | |
MRSA respiratory tract infections | 7.0 | 1998 | |
MRSA skin and soft tissue infections and surgical site infections | 1.4 | 1998 | |
MRSA bone and joint infections | 9.8 |
d
| |
GRE invasive infections | 25.0 | [14] | 2002 |
GRE urinary tract infections | 9.0 | [14] | 2002 |
GRE gastrointestinal tract infections | 3.0 | [14] | 2002 |
GRE skin and soft tissue infections and surgical site infections | 6.0 | [14] | 2002 |
3GC-R E. coli invasive infections | 18.0 | [20] | 2010 |
3GC-R E. coli urinary tract infections | 0.0 | [21] | 2006 |
3GC-R E. coli respiratory tract infections | 12.9 | 1998 | |
3GC-R E. coli skin and soft tissue infections and surgical site infections | 2.6 | 1998 | |
3GC-R K. pneumoniae invasive infections | 18.0 | [20] | 2010 |
3GC-R K. pneumoniae urinary tract infections | 0.4 | 1998 | |
3GC-R K. pneumoniae respiratory tract infections | 12.9 | 1998 | |
3GC-R K. pneumoniae skin and soft tissue infections and surgical site infections | 2.6 | 1998 | |
CR K. pneumoniae invasive infections | 37.0 | [22] | 2010 |
CR K. pneumoniae urinary tract infections | 0.8 | 1998 | |
CR K. pneumoniae respiratory tract infections | 26.4 | 1998 | |
3GC-R K. pneumoniae skin and soft tissue infections and surgical site infections | 5.4 | 1998 | |
CR P. aeruginosa invasive infections | 33.0 | [23] | 2010 |
CR P. aeruginosa urinary tract infections | 0.8 | 1998 | |
CR P. aeruginosa respiratory infections | 23.6 | 1998 | |
CR P. aeruginosa skin and soft tissue infections and surgical site infections | 4.8 | 1998 | |
CR Acinetobacter invasive infections | 36.5 | [24] | 2007 |
CR Acinetobacter urinary tract infections | 0.8 | 1998 | |
CR Acinetobacter respiratory infections | 26.1 | 1998 | |
CR Acinetobacter skin and soft tissue infections and surgical site infections | 5.3 | 1998 |
Results
Estimate of EARS-Net coverage, France
Number of infections due to MDRB
MDRB | Body site | Total number of cases (%) | Incidence per 1,000 HD | |||||||
---|---|---|---|---|---|---|---|---|---|---|
PPS ratio | Ratios from literature | PPS ratio | Ratios from literature | |||||||
Low value | High value | Low value | High value | |||||||
MRSA | Invasive inf. | 5,574 | (10.8%) | 5,574 | (11.5%) | 5,574 | (8.0%) | 0.065 | 0.065 | 0.065 |
Others | 46,270 | (89.2%) | 42,852 | (88.5%) | 63,710 | (92.0%) | 0.538 | 0.498 | 0.741 | |
Total | 51,844 | (100%) | 48,426 | (100%) | 69,284 | (100%) | 0.603 | 0.563 | 0.806 | |
GRE | Invasive inf. | 39 | (10.6%) | 39 | (10.1%) | 39 | (8.3%) | <0.001 | <0.001 | <0.001 |
Others | 328 | (89.4%) | 345 | (89.9%) | 430 | (91.7%) | 0.004 | 0.004 | 0.005 | |
Total | 367 | (100%) | 384 | (100%) | 469 | (100%) | 0,004 | 0,004 | 0,005 | |
3GC-R E. coli.
| Invasive inf. | 5,690 | (11.2%) | 5,690 | (17.4%) | 5,690 | (7.2%) | 0.066 | 0.066 | 0.066 |
Others | 45,226 | (88.8%) | 27,028 | (82.6%) | 73,395 | (92.8%) | 0.526 | 0.314 | 0.854 | |
Total | 50,916 | (100%) | 32,719 | (100%) | 79,085 | (100%) | 0.592 | 0.381 | 0.920 | |
3GC-R K. pneumoniae
| Invasive inf. | 2,246 | (13.8%) | 2,246 | (27.0%) | 2,246 | (9.3%) | 0.026 | 0.026 | 0.026 |
Others | 14,068 | (86.2%) | 6,087 | (73.0%) | 21,789 | (90.7%) | 0.164 | 0.071 | 0.253 | |
Total | 16,314 | (100%) | 8,333 | (100%) | 24,035 | (100%) | 0,190 | 0.097 | 0.280 | |
CR K. pneumoniae
| Invasive inf. | 94 | (13.8%) | 94 | (21.3%) | 94 | (15.9%) | 0.001 | 0.001 | 0.001 |
Others | 589 | (86.2%) | 349 | (78.7%) | 500 | (84.1%) | 0.007 | 0.004 | 0.006 | |
Total | 683 | (100%) | 443 | (100%) | 594 | (100%) | 0.008 | 0.005 | 0.007 | |
CR P. aeruginosa
| Invasive inf. | 2,141 | (5.8%) | 2,141 | (5.8%) | 2,141 | (3.0%) | 0.025 | 0.025 | 0.025 |
Others | 34,616 | (94.2%) | 34,616 | (94.2%) | 68,442 | (97.0%) | 0.403 | 0.403 | 0.796 | |
Total | 36,757 | (100%) | 36,757 | (100%) | 70,583 | (100%) | 0.428 | 0.428 | 0.821 | |
CR Acinetobacter spp
| Invasive inf. | 111 | (14.4%) | 111 | (35.5%) | 111 | (14.6%) | 0.001 | 0.001 | 0.001 |
Others | 660 | (85.6%) | 202 | (64.5%) | 647 | (85.4%) | 0.008 | 0.003 | 0.008 | |
Total | 771 | (100%) | 313 | (100%) | 758 | (100%) | 0.009 | 0.004 | 0.009 | |
Total invasive inf. | 15,895 | (10.1%) | 15,895 | (12.5%) | 15,895 | (6.5%) | 0.185 | 0.185 | 0.185 | |
TOTAL | 157,652 | (100%) | 127,375 | (100%) | 244,808 | (100%) | 1.834 | 1.481 | 2.847 |
Number of deaths associated with infections due to MDRB
MDRB | Number of deaths associated with MDRB | Incidence per 1,000 HD | |||||||
---|---|---|---|---|---|---|---|---|---|
PPS ratios | Ratios from literature | PPS ratios | Ratios from literature | ||||||
Low value | High value | Low value | High value | ||||||
Gram + | |||||||||
MRSA | 2,236 | (18.0%) | 1,855 | (16.2%) | 2,711 | (15.5%) | 0.026 | 0.022 | 0.032 |
GRE | 31 | (0.3%) | 31 | (0.3%) | 36 | (0.2%) | <0.001 | <0.001 | <0.001 |
Subtotal Gram +
| 2,268 | (18.3%) | 1,886 | (16.5%) | 2,747 | (15.7%) | 0.026 | 0.022 | 0.032 |
Gram - | |||||||||
3GC-R E. coli.
| 2,020 | (16.3%) | 2,020 | (17.7%) | 3,584 | (20.5%) | 0.023 | 0.023 | 0.042 |
3GC-R K. pneumoniae
| 1,217 | (9.8%) | 779 | (6.8%) | 1,436 | (8.2%) | 0.014 | 0.009 | 0.017 |
CR K. pneumoniae
| 116 | (0.9%) | 49 | (0.4%) | 80 | (0.5%) | 0.001 | 0.001 | 0.001 |
CR P. aeruginosa
| 6,610 | (53.3%) | 6,610 | (57.9%) | 9,464 | (54.2%) | 0.077 | 0.077 | 0.110 |
CR Acinetobacter spp
| 180 | (1.4%) | 78 | (0.7%) | 159 | (0.9%) | 0.002 | 0.001 | 0.002 |
Subtotal Gram -
| 10,143 | (81.7%) | 9,536 | (83.5%) | 14,723 | (84.3%) | 0.118 | 0.111 | 0.171 |
TOTAL | 12,411 | (100%) | 11,422 | (100%) | 17,470 | (100%) | 0.144 | 0.133 | 0.203 |