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Antimicrobial Resistance and Infection Control

, 5:56

First Online: 12 December 2016Received: 24 June 2016Accepted: 24 November 2016


BackgroundA study based on 2007 data estimated that 386,000 infections due to multidrug-resistant bacteria MDRB occurred in Europe that year and 25,000 patients died from these infections. Our objective was to estimate the morbidity and mortality associated with these infections in France.

MethodsThe MDRB considered were methicillin-resistant Staphylococcus aureus MRSA, glycopeptide-resistant enterococci, third-generation cephalosporin-resistant 3GC-R Escherichia coli and Klebsiella pneumoniae, carbapenem-resistant Klebsiella pneumoniae, Acinetobacter spp. and Pseudomonas aeruginosa CR P. aeruginosa. The number of invasive infections infections with bacteria isolated from blood or cerebrospinal fluid due to MDRB, as reported by France to EARS-Net in 2012, was corrected for the coverage of our surveillance network and extrapolated to other body sites using ratios from the French healthcare-associated infections point prevalence survey and the literature. Mortality associated with MDRB infection was estimated using proportions from the literature. Methods and parameters were reviewed by a panel of experts.

ResultsWe estimate that 158,000 127,000 to 245,000 infections due to MDRB occurred in 2012 in France incidence: 1.48 to 2.85 per 1000 hospital days, including 16,000 invasive infections. MRSA, 3GC-R E. coli and K. pneumoniae were responsible for 120,000 90,000 to 172,000 infections, i.e., 75% of the total. An estimated 12,500 11,500 to 17,500 deaths were associated with these infections, including 2,700 associated with invasive infections. MRSA, 3GC-R E. coli and CR P. aeruginosa accounted for 88% of these deaths.

ConclusionThese first estimates confirm that MRSA, 3GC-R Escherichia coli and Klebsiella pneumoniae account for the largest portion of the morbidity and mortality of infections due to MDRB in France. These results are not directly comparable with the European study because the methodology used differs in many respects. The differences identified between our study and previous studies underline the need to define a standardised protocol for international assessments of the morbidity and mortality of antibiotic resistance. Estimating morbidity and mortality will facilitate communication and awareness in order to reinforce adherence and support of healthcare professionals and policy-makers to MDRB prevention programs.

KeywordsAntimicrobial resistance Epidemiology Morbidity Mortality Infection due to multidrug resistant bacteria France Abbreviations3GC-R E. coliEscherichia coli resistant to third-generation cephalosporins

3GC-R K. pneumoniaeKlebsiella pneumoniae resistant to third-generation cephalosporins

3GC-RThird-generation cephalosporin-resistant

CDCUS Centers for disease control and prevention

CR Acinetobacter sppAcinetobacter spp. resistant to carbapenems

CR K. pneumoniaeK. pneumoniae resistant to carbapenems

CR P. aeruginosaPseudomonas aeruginosa resistant to carbapenems

EARS-NetEuropean antimicrobial resistance surveillance network

ECDCEuropean centre for disease prevention and control

ESBLExtended-spectrum beta-lactamase producing enterobacteriaceae

EU-EEA countriesEuropean union and European economic area countries

GREEnterococcus faecium and E. faecalis resistant to glycopeptides

HDInpatient hospital days

MDRMultidrug resistant

MDRBMultidrug resistant bacteria

MRSAMethicillin-resistant Staphylococcus aureus

PPS 2012Point prevalence survey of healthcare-associated infections and antimicrobial use in French hospitals in 2012

Electronic supplementary materialThe online version of this article doi:10.1186-s13756-016-0154-z contains supplementary material, which is available to authorized users.

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Autor: M. Colomb-Cotinat - J. Lacoste - C. Brun-Buisson - V. Jarlier - B. Coignard - S. Vaux


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