1887
  1. Home
  2. Eurosurveillance
  3. Volume 27, Issue 46, 17/Nov/2022
  4. Article
Surveillance Open Access
Like 0
Download

Abstract

Background

Surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) in Europe is currently annual.

Aim

To study the feasibility and scalability of a quarterly AMR/AMU surveillance system in the European Union/European Economic Area (EU/EEA).

Methods

We conducted a longitudinal study within the scope of the EU-JAMRAI project. Seventeen partners from 11 EU/EEA countries prospectively collected 41 AMU and AMR indicators quarterly from September 2017 to May 2020 for the hospital sector (HS) and primary care (PC). Descriptive statistics and coefficients of variation (CV) analysis were performed.

Results

Data from 8 million hospital stays and 45 million inhabitants per quarter were collected at national (n = 4), regional (n = 6) and local (n = 7) levels. Of all partners, five were able to provide data within 3 months after each preceding quarter, and eight within 3–6 months. A high variability in AMU was found between partners. Colistin was the antibiotic that showed the highest CV in HS (1.40; p < 0.0001). Extended-spectrum beta-lactamase-producing presented the highest incidence in HS (0.568 ± 0.045 cases/1,000 bed-days per quarter), whereas ciprofloxacin-resistant showed the highest incidence in PC (0.448 ± 0.027 cases/1,000 inhabitants per quarter). Barriers and needs for implementation were identified.

Conclusion

This pilot study could be a first step towards the development of a quarterly surveillance system for AMU and AMR in both HS and PC in the EU/EEA. However, committed institutional support, dedicated human resources, coordination of data sources, homogeneous indicators and modern integrated IT systems are needed first to implement a sustainable quarterly surveillance system.

© 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.2022.27.46.2200082
2022-11-17
2024-04-20
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.46.2200082
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/27/46/eurosurv-27-46-6.html?itemId=/content/10.2807/1560-7917.ES.2022.27.46.2200082&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). Antimicrobial resistance: global report on surveillance. Geneva: WHO; 2014. Available from: https://www.who.int/publications/i/item/9789241564748
  2. World Health Organization (WHO). The evolving threat of antimicrobial resistance: Options for action. Geneva: WHO; 2012. Available from: https://apps.who.int/iris/handle/10665/44812
  3. Holmes AH, Moore LSP, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016;387(10014):176-87.  https://doi.org/10.1016/S0140-6736(15)00473-0  PMID: 26603922 
  4. Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42(Suppl 2):S82-9.  https://doi.org/10.1086/499406  PMID: 16355321 
  5. Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-55.  https://doi.org/10.1016/S0140-6736(21)02724-0  PMID: 35065702 
  6. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019;19(1):56-66.  https://doi.org/10.1016/S1473-3099(18)30605-4  PMID: 30409683 
  7. O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. Review on antimicrobial resistance. London: Wellcome Trust and HM Government; 2016.
  8. European Centre for Disease Prevention and Control (ECDC) and European Medicines Agency. (EMEA) Joint Working Group. ECDC/EMEA Joint Technical Report: The bacterial challenge: time to react. Stockholm: ECDC and EMEA; 2009. Available from: https://www.ecdc.europa.eu/en/publications-data/ecdcemea-joint-technical-report-bacterial-challenge-time-react
  9. World Health Organization (WHO). Global action plan on AMR. Geneva: WHO; 2015. Available from: https://www.who.int/publications/i/item/9789241509763
  10. European Commission (EC). A European One Health Action Plan against Antimicrobial Resistance. Brussels: EC; 2017. Available from: https://ec.europa.eu/health/sites/health/files/antimicrobial_resistance/docs/amr_2017_action-plan.pdf
  11. Council of the European Union. Council conclusions on the next steps towards making the EU a best practice region in combatting antimicrobial resistance. Luxembourg: Publications Office of the European Union. 25.6.2019:C 214. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52019XG0625(01)&from=EN
  12. Mader R, Damborg P, Amat J-P, Bengtsson B, Bourély C, Broens EM, et al. Building the European Antimicrobial Resistance Surveillance network in veterinary medicine (EARS-Vet). Euro Surveill. 2021;26(4):2001359.  https://doi.org/10.2807/1560-7917.ES.2021.26.4.2001359  PMID: 33509339 
  13. Anderson M, Clift C, Schulze K, Sagan A, Driss SN, Ouakrim A, et al. Averting the AMR crisis. What are the avenues for policy action for countries in Europe? Copenhagen: WHO European Observatory on Health Systems and Policies; 2019.  PMID: 31287637 
  14. European Centre for Disease Prevention and Control (ECDC). European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC. [Accessed: 1 Feb 2020]. Available from: https://www.ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/ears-net
  15. European Centre for Disease Prevention and Control (ECDC). European Surveillance of Antimicrobial Consumption Network (ESAC-Net). Stockholm: ECDC. [Accessed: 1 Feb 2020]. Available from: https://www.ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/esac-net
  16. Tacconelli E, Sifakis F, Harbarth S, Schrijver R, van Mourik M, Voss A, et al. Surveillance for control of antimicrobial resistance. Lancet Infect Dis. 2018;18(3):e99-106.  https://doi.org/10.1016/S1473-3099(17)30485-1  PMID: 29102325 
  17. Molina J, Peñalva G, Gil-Navarro MV, Praena J, Lepe JA, Pérez-Moreno MA, et al. Long-Term Impact of an Educational Antimicrobial Stewardship Program on Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections: A Quasi-Experimental Study of Interrupted Time-Series Analysis. Clin Infect Dis. 2017;65(12):1992-9.  https://doi.org/10.1093/cid/cix692  PMID: 29020166 
  18. Peñalva G, Fernández-Urrusuno R, Turmo JM, Hernández-Soto R, Pajares I, Carrión L, et al. Long-term impact of an educational antimicrobial stewardship programme in primary care on infections caused by extended-spectrum β-lactamase-producing Escherichia coli in the community: an interrupted time-series analysis. Lancet Infect Dis. 2020;20(2):199-207.  https://doi.org/10.1016/S1473-3099(19)30573-0  PMID: 31767423 
  19. Rojo-Martín MD, Peñalva G, Pinto C, Salcedo I, Fernández-Urrusuno R, Cabeza J, et al. The PIRASOA programme: design, structure, organisation and indicators of a comprehensive regional Institutional Programme for the Prevention and Control of Healthcare-associated Infections and Antimicrobial Stewardship for hospitals and primary care settings in Andalusia, Spain, V2. www.protocols.io. [Accessed: 28 Jul 2018]. Available from: https://www.protocols.io/view/the-pirasoa-programme-design-structure-organisatio-r3bd8in/abstract
  20. Rodríguez-Baño J, Pérez-Moreno MA, Peñalva G, Garnacho-Montero J, Pinto C, Salcedo I, et al. Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis. Clin Microbiol Infect. 2020;26(3):358-65.  https://doi.org/10.1016/j.cmi.2019.07.009  PMID: 31323260 
  21. WHO Collaborating Center for Drug Statistics Methodology. DDD: Definition and general considerations. Oslo: Norwegian Institute of Public Health. [Accessed: 29 Aug 2018]. Available from: https://www.whocc.no/ddd/definition_and_general_considera
  22. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 8.0. Växjö: EUCAST; 2018. Available from: http://www.eucast.org
  23. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). EUCAST guideline for the detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. Version 2.0. Växjö: EUCAST; 2017. Available from: http://www.eucast.org
  24. Feltz CJ, Miller GE. An asymptotic test for the equality of coefficients of variation from k populations. Stat Med. 1996;15(6):646-58.  https://doi.org/10.1002/(SICI)1097-0258(19960330)15:6<647::AID-SIM184>3.0.CO;2-P  PMID: 8731006 
  25. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2020. Available from: https://www.R-project.org
  26. Marwick B, Krishnamoorthy K. cvequality: Tests for the Equality of Coefficients of Variation from Multiple Groups. R software package version 0.1.3. Github.com; 2019. Available from: https://github.com/benmarwick/cvequality
  27. Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015;109(7):309-18.  https://doi.org/10.1179/2047773215Y.0000000030  PMID: 26343252 
  28. Hutchinson JM, Patrick DM, Marra F, Ng H, Bowie WR, Heule L, et al. Measurement of antibiotic consumption: A practical guide to the use of the Anatomical Thgerapeutic Chemical classification and Definied Daily Dose system methodology in Canada. Can J Infect Dis. 2004;15(1):29-35.  https://doi.org/10.1155/2004/389092  PMID: 18159441 
  29. Molina J, Peñalva G, Lepe JA, Valencia R, Gil-Navarro MV, Cisneros JM. Novel Indicators for Enhancing the Clinical Outcome Metrics of Antimicrobial Stewardship Programs. Infect Control Hosp Epidemiol. 2018;39(6):758-9.  https://doi.org/10.1017/ice.2018.65  PMID: 29618395 
  30. Rawson TM, Moore LSP, Castro-Sanchez E, Charani E, Davies F, Satta G, et al. COVID-19 and the potential long-term impact on antimicrobial resistance. J Antimicrob Chemother. 2020;75(7):1681-4.  https://doi.org/10.1093/jac/dkaa194  PMID: 32433765 
  31. Guisado-Gil A, Infante-Domínguez C, Peñalva G, Praena J, Roca C, Navarro-Amuedo M, et al. Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections. Antibiotics (Basel). 2020;9(11):816.  https://doi.org/10.3390/antibiotics9110816 
  32. Abelenda-Alonso G, Padullés A, Rombauts A, Gudiol C, Pujol M, Alvarez-Pouso C, et al. Antibiotic prescription during the COVID-19 pandemic: A biphasic pattern. Infect Control Hosp Epidemiol. 2020;41(11):1371-2.  https://doi.org/10.1017/ice.2020.381  PMID: 32729437 
  33. Peñalva G, Benavente RS, Pérez-Moreno MA, Pérez-Pacheco MD, Pérez-Milena A, Murcia J, et al. Effect of the coronavirus disease 2019 pandemic on antibiotic use in primary care. Clin Microbiol Infect. 2021;27(7):1058-60.  https://doi.org/10.1016/j.cmi.2021.01.021  PMID: 33540117 
  34. European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance in the EU/EEA (EARS-Net), Annual Epidemiological Report for 2019. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-resistance-europe-2019
A step forward in antibiotic use and resistance monitoring: a quarterly surveillance system pilot in 11 European Union/European Economic Area countries, September 2017 to May 2020
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Germ%C3%A1n+Pe%C3%B1alva&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Peñalva Germán</a>, <a href="/search?value1=Paloma+Crespo-Robledo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Crespo-Robledo Paloma</a>, <a href="/search?value1=Mari+Molvik&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Molvik Mari</a>, <a href="/search?value1=Antonio+L%C3%B3pez-Navas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">López-Navas Antonio</a>, <a href="/search?value1=Oliver+Kacelnik&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kacelnik Oliver</a>, <a href="/search?value1=Jos%C3%A9+Miguel+Cisneros&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cisneros José Miguel</a>, <a href="/search?value1=EU-JAMRAI+WP7.4.1+group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">EU-JAMRAI WP7.4.1 group</a></span>. A step forward in antibiotic use and resistance monitoring: a quarterly surveillance system pilot in 11 European Union/European Economic Area countries, September 2017 to May 2020. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(46):pii=2200082. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.46.2200082" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.46.2200082</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 21 Jan 2022;&nbsp;&nbsp; <span class="generated">Accepted</span>: 31 Aug 2022 </span> </p>
/content/10.2807/1560-7917.ES.2022.27.46.2200082
/content/10.2807/1560-7917.ES.2022.27.46.2200082
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