title: Estimating the morbidity and mortality associated with infections due to multidrug-resistant bacteria (MDRB), France, 2012.
abstract: BACKGROUND
  A 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.
  
  
  METHODS
  The MDRB considered were methicillin-resistantStaphylococcus aureus(MRSA), glycopeptide-resistantenterococci, third-generation cephalosporin-resistant (3GC-R)Escherichia coliandKlebsiella pneumoniae, carbapenem-resistantKlebsiella pneumoniae,Acinetobacterspp. andPseudomonas aeruginosa(CRP. 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.
  
  
  RESULTS
  We 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-RE. coliandK. pneumoniaewere 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-RE. coliand CRP. aeruginosaaccounted for 88% of these deaths.
  
  
  CONCLUSIONS
  These first estimates confirm that MRSA, 3GC-REscherichia coliandKlebsiella pneumoniaeaccount 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.
authors.affiliation: Santé Publique France, The French Public Health Agency, F-94415 Saint-Maurice, France.
authors.forename: M
authors.identifier: 0000-0002-2436-3274
authors.initials: M
authors.lastname: Colomb-Cotinat
authors.affiliation: Santé Publique France, The French Public Health Agency, F-94415 Saint-Maurice, France.
authors.forename: J
authors.initials: J
authors.lastname: Lacoste
authors.affiliation: Assistance publique-hôpitaux de Paris, CHU Henri Mondor, F-94000 Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, Inserm, Centre d'Immunologie et des Maladies Infectieuses, UMR 1135 & APHP, CHU Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, F-75013 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Jarlier
authors.affiliation: Santé Publique France, The French Public Health Agency, F-94415 Saint-Maurice, France.
authors.forename: B
authors.initials: B
authors.lastname: Coignard
authors.affiliation: Santé Publique France, The French Public Health Agency, F-94415 Saint-Maurice, France.
authors.forename: S
authors.initials: S
authors.lastname: Vaux
keywords: Antimicrobial resistance; Epidemiology; France; Infection due to multidrug resistant bacteria; Morbidity; Mortality