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. 2019 Nov;24(46):1900135.
doi: 10.2807/1560-7917.ES.2019.24.46.1900135.

Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012

Benedikt Zacher  1   2 , Sebastian Haller  1   2 , Niklas Willrich  1 , Jan Walter  1 , Muna Abu Sin  1 , Alessandro Cassini  3 , Diamantis Plachouras  3 , Carl Suetens  3 , Michael Behnke  4 , Petra Gastmeier  4 , Lothar H Wieler  1 , Tim Eckmanns  1
Affiliations

Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012

Benedikt Zacher et al. Euro Surveill. 2019 Nov.

Abstract

BackgroundHealthcare-associated infections (HAIs) pose a major challenge to health systems. Burden of disease estimations in disability-adjusted life years (DALYs) are useful for comparing and ranking HAIs.AimTo estimate the number of five common HAIs, their attributable number of deaths and burden for Germany.MethodsWe developed a new method and R package that builds on the approach used by the Burden of Communicable Diseases in Europe (BCoDE) project to estimate the burden of HAIs for individual countries. We used data on healthcare-associated Clostridioides difficile infection, healthcare-associated pneumonia, healthcare-associated primary bloodstream infection, healthcare-associated urinary tract infection and surgical-site infection, which were collected during the point prevalence survey of HAIs in European acute-care hospitals between 2011 and 2012.ResultsWe estimated 478,222 (95% uncertainty interval (UI): 421,350-537,787) cases for Germany, resulting in 16,245 (95% UI: 10,863-22,756) attributable deaths and 248,920 (95% UI: 178,693-336,239) DALYs. Despite the fact that Germany has a relatively low hospital prevalence of HAIs compared with the European Union/European Economic Area (EU/EEA) average, the burden of HAIs in Germany (308.2 DALYs/100,000 population; 95% UI: 221.2-416.3) was higher than the EU/EEA average (290.0 DALYs/100,000 population; 95% UI: 214.9-376.9). Our methodology is applicable to other countries in or outside of the EU/EEA. An R package is available from https://CRAN.R-project.org/package=BHAI.ConclusionThis is the first study to estimate the burden of HAIs in DALYs for Germany. The large number of hospital beds may be a contributing factor for a relatively high burden of HAIs in Germany. Further focus on infection prevention control, paired with reduction of avoidable hospital stays, is needed to reduce the burden of HAIs in Germany.

Keywords: Disability-adjusted Life Years; Point prevalence Survey; burden of disease; healthcare-associated infections.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Overview of the workflow of the estimation of the burden of healthcare-associated infections implemented in the BHAI R package
Figure 2
Figure 2
Annual number of healthcare-associated infections plotted against the annual number of attributable deaths for five types of healthcare-associated infectionsa, Germany, 2011
Figure 3
Figure 3
Annual burden of five types of healthcare-associated infections with (A) attributable deaths per 100,000 population and (B) disability-adjusted life years per 100,000 population, Germany, EU/EEA, 2011–2012
Figure 4
Figure 4
Total annual burden of five types of healthcare-associated infectionsa in Germany (left) and EU/EEA (right), stratified by age and sex and within each stratum the (A-B) total number of DALYs and (C-D) DALYs per 100,000 population, Germany, EU/EEA, 2011–2012
See this image and copyright information in PMC

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