title: Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cassini
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors.forename: Diamantis
authors.identifier: http://orcid.org/0000-0001-9637-7803
authors.initials: D
authors.lastname: Plachouras
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Eckmanns
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Muna
authors.initials: M
authors.lastname: Abu Sin
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Hans-Peter
authors.identifier: http://orcid.org/0000-0003-2740-6361
authors.initials: HP
authors.lastname: Blank
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Ducomble
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Sebastian
authors.identifier: http://orcid.org/0000-0001-8242-711X
authors.initials: S
authors.lastname: Haller
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Harder
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Anja
authors.identifier: http://orcid.org/0000-0002-5394-3374
authors.initials: A
authors.lastname: Klingeberg
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Madlen
authors.initials: M
authors.lastname: Sixtensson
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Edward
authors.initials: E
authors.lastname: Velasco
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Weiß
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kramarz
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors.forename: Dominique L
authors.initials: DL
authors.lastname: Monnet
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Mirjam E
authors.initials: ME
authors.lastname: Kretzschmar
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors.forename: Carl
authors.initials: C
authors.lastname: Suetens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D017281:Cost of Illness; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D006233:Persons with Disabilities; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents