Germany’s Burden of Disease of Bloodstream Infections Due to Vancomycin-Resistant <i>Enterococcus faecium</i> between 2015–2020

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

• burden of disease
• bloodstream infection
• antimicrobial resistance
• vancomycin-resistance
• Enterococcus faecium
• VRE