Michael H Wilke1, Birgit Preisendörfer2, Anna Seiffert3, Maria Kleppisch4,5, Caroline Schweizer4,5, Stephan Rauchensteiner4,5. 1. Medical School Hamburg (MSH), Am Kaiserkai 1, 20456, Hamburg, Germany. Michael.wilke@medicalschool-hamburg.de. 2. Inspiring-Health GmbH, Waldmeisterstrasse 72, 80935, Munich, Germany. 3. Gesundheitsforen Leipzig GmbH, Hainstraße 16, 04109, Leipzig, Germany. 4. Health Technology Assessment and Outcomes Research (HTA&OR), Health and Value Germany, Pfizer Pharma GmbH, Linkstraße 10, 10785, Berlin, Germany. 5. Hospital Business Unit Germany, Pfizer Pharma GmbH, Linkstraße 10, 10785, Berlin, Germany.
Abstract
PURPOSE: Infections with carbapenem-resistant gram-negative bacteria (in Germany classified as 4MRGN) are a growing threat in clinical care. This study was undertaken to understand the overall burden of 4MRGN infections in Germany in the context of a Health Technology Appraisal (HTA) for Ceftazidime/Avibactam (CAZ/AVI). Besides, the incidences mortality was an endpoint of interest. METHODS: To assess infections with carbapenem-resistant gram-negative bacteria and related mortality, three different data sources have been used. From the German statistics office (DESTATIS) data have been retrieved to obtain the overall frequency these pathogens. Via two other databases, the German analysis database (DADB) and a Benchmarking of > 200 hospitals in a representative sample (BM-DB), the distribution of the infections and the mortality have been analyzed. RESULTS: DESTATIS data showed a total of 11,863 carbapenem-resistant gram-negative bacteria codings, of which 10,348 represent infections and 1515 carriers. The most frequent infections were complicated urinary tract infections (cUTI) (n = 2,337), followed by pneumonia (n = 1006) and intra-abdominal infections (n = 730). A considerable amount of patients had multiple infections in one hospital episode (n = 1258). In-hospital mortality was 18.6% in DADB and 14.3% in the BM-DB population, respectively. In cases with additional bloodstream infections, DADB mortality was correspondingly higher at 33.0%. DADB data showed an incremental mortality increase of 5.7% after 30 days and 10.0% after 90 days resulting in a cumulative 90 day mortality of 34.3%. CONCLUSIONS: Infections with carbapenem-resistant gram-negative bacteria are still rare (6.8-12.4 per 100,000) but show a significant increase in mortality compared to infections with more sensitive pathogens. Using different data sources allowed obtaining a realistic picture.
PURPOSE: Infections with carbapenem-resistant gram-negative bacteria (in Germany classified as 4MRGN) are a growing threat in clinical care. This study was undertaken to understand the overall burden of 4MRGN infections in Germany in the context of a Health Technology Appraisal (HTA) for Ceftazidime/Avibactam (CAZ/AVI). Besides, the incidences mortality was an endpoint of interest. METHODS: To assess infections with carbapenem-resistant gram-negative bacteria and related mortality, three different data sources have been used. From the German statistics office (DESTATIS) data have been retrieved to obtain the overall frequency these pathogens. Via two other databases, the German analysis database (DADB) and a Benchmarking of > 200 hospitals in a representative sample (BM-DB), the distribution of the infections and the mortality have been analyzed. RESULTS: DESTATIS data showed a total of 11,863 carbapenem-resistant gram-negative bacteria codings, of which 10,348 represent infections and 1515 carriers. The most frequent infections were complicated urinary tract infections (cUTI) (n = 2,337), followed by pneumonia (n = 1006) and intra-abdominal infections (n = 730). A considerable amount of patients had multiple infections in one hospital episode (n = 1258). In-hospital mortality was 18.6% in DADB and 14.3% in the BM-DB population, respectively. In cases with additional bloodstream infections, DADB mortality was correspondingly higher at 33.0%. DADB data showed an incremental mortality increase of 5.7% after 30 days and 10.0% after 90 days resulting in a cumulative 90 day mortality of 34.3%. CONCLUSIONS: Infections with carbapenem-resistant gram-negative bacteria are still rare (6.8-12.4 per 100,000) but show a significant increase in mortality compared to infections with more sensitive pathogens. Using different data sources allowed obtaining a realistic picture.
Authors: Carolin Fleischmann; Daniel O Thomas-Rueddel; Michael Hartmann; Christiane S Hartog; Tobias Welte; Steffen Heublein; Ulf Dennler; Konrad Reinhart Journal: Dtsch Arztebl Int Date: 2016-03-11 Impact factor: 5.594
Authors: Dale W Bratzler; Sharon-Lise T Normand; Yun Wang; Walter J O'Donnell; Mark Metersky; Lein F Han; Michael T Rapp; Harlan M Krumholz Journal: PLoS One Date: 2011-04-12 Impact factor: 3.240