Germany's Burden of Disease of Bloodstream Infections Due to Vancomycin-Resistant Enterococcus faecium between 2015-2020

Simon Brinkwirth; Sofie Martins; Olaniyi Ayobami; Marcel Feig; Ines Noll; Benedikt Zacher; Tim Eckmanns; Guido Werner; Niklas Willrich; Sebastian Haller

doi:10.3390/microorganisms10112273

Germany's Burden of Disease of Bloodstream Infections Due to Vancomycin-Resistant Enterococcus faecium between 2015-2020

Microorganisms. 2022 Nov 16;10(11):2273. doi: 10.3390/microorganisms10112273.

Authors

Simon Brinkwirth^{1

2

3}, Sofie Martins⁴, Olaniyi Ayobami¹, Marcel Feig⁵, Ines Noll¹, Benedikt Zacher⁶, Tim Eckmanns¹, Guido Werner⁷, Niklas Willrich¹, Sebastian Haller¹

Affiliations

¹ Unit 37: Healthcare-Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany.
² Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, 13353 Berlin, Germany.
³ European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), 16973 Solna, Sweden.
⁴ CP3-Origins & IMADA, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark.
⁵ Unit IT4: Development, Department of Methods Development, Research Infrastructure and Information Technology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany.
⁶ Unit 32: Surveillance and Electronic Reporting and Information System (DEMIS), Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany.
⁷ Unit 13: Nosocomial Pathogens and Antibiotic Resistances, National Reference Centre for Staphylococci and Enterococci, Department of Infectious Diseases, Robert Koch Institute, Burgstr. 37, 38855 Wernigerode, Germany.

Abstract

In Germany, there is an increasing amount of vancomycin-resistant Enterococcus faecium (VREfm) isolates in bloodstream infections (BSIs); however, estimates on recent incidences and disease burden are missing. We aim to estimate the incidence and calculate the annual disease burden in disease-adjusted life years (DALYs) for BSIs due to VREfm in Germany between 2015 and 2020 to support informed decision-making in the field of antimicrobial resistance (AMR). We used the Antibiotic Resistance Surveillance (ARS) system data to obtain incidence estimates. The estimated incidences were used in the Burden of Communicable Disease in Europe (BCoDE) toolkit to calculate the attributable DALYs. A total of 3417 VREfm blood culture-positive isolates were observed within ARS. The estimated incidence of VREfm-BSIs per 100,000 inhabitants increased from 1.4 (95% Uncertainty Interval [UI]: 0.8−1.9) in 2015 to 2.9 (95% UI: 2.4−3.3) in 2020. The estimated burden, expressed in DALYs per 100,000 inhabitants, increased from 8.5 (95% UI: 7.3−9.7; YLD = 0.9, YLL = 7.6) in 2015 to 15.6 (95% UI: 14.6−16.6; YLD = 1.6, YLL = 14) in 2020. The most affected groups within the observed period are the 65−69-year-old males with 262.9 DALYs per 100,000 inhabitants, and in the younger age groups (<30 years), the under-one-year-old with 43.1 DALYs per 100,000 inhabitants and 34.5 DALYs for male and female, respectively. The increasing DALYs of BSIs due to VREfm require targeted prevention and control measures to address their unequal distribution across gender and age, especially for older hospitalized patients, neonates, and infants in Germany.

Keywords: DALYs; Enterococcus faecium; VRE; VREfm; antimicrobial resistance; bloodstream infection; burden of disease; vancomycin-resistance.

Grants and funding

This work was supported by internal funds from the Robert Koch Institute. S.B. is a fellow of the ECDC Fellowship Programme, supported financially by the European Centre for Disease Prevention and Control The views and opinions expressed herein do not state or reflect those of ECDC. ECDC is not responsible for the data and information collation and analysis and cannot be held liable for conclusions or opinions drawn.