Occurrence of invasive pneumococcal disease and number of excess cases due to influenza

Abstract Background Influenza is characterized by seasonal outbreaks, often with a high rate of morbidity and mortality. It is also known to be a cause of significant amount secondary bacterial infections. Streptococcus pneumoniae is the main pathogen causing secondary bacterial pneumonia after influenza and subsequently, influenza could participate in acquiring Invasive Pneumococcal Disease (IPD). Methods In this study, we aim to investigate the relation between influenza and IPD by estimating the yearly excess of IPD cases due to influenza. For this purpose, we use influenza periods as an indicator for influenza activity as a risk factor in subsequent analysis. The statistical modeling has been made in two modes. First, we constructed two negative binomial regression models. For each model, we estimated the contribution of influenza in the models, and calculated number of excess number of IPD cases. Also, for each model, we investigated several lag time periods between influenza and IPD. Secondly, we constructed an "influenza free" baseline, and calculated differences in IPD data (observed cases) and baseline (expected cases), in order to estimate a yearly additional number of IPD cases due to influenza. Both modes were calculated using zero to four weeks lag time. Results The analysis shows a yearly increase of 72–118 IPD cases due to influenza, which corresponds to 6–10% per year or 12–20% per influenza season. Also, a lag time of one to three weeks appears to be of significant importance in the relation between IPD and influenza. Conclusion This epidemiological study confirms the association between influenza and IPD. Furthermore, negative binomial regression models can be used to calculate number of excess cases of IPD, related to influenza.</p

Large increase in bloodstream infections with carbapenem-resistant Acinetobacter species during the first 2 years of the COVID-19 pandemic, EU/EEA, 2020 and 2021

EARS-Net Study Group (Portugal: Manuela Caniça).EARS-Net Study Group participants: Reinhild Strauss, Karl Mertens, Stefana Sabtcheva, Arjana Tambic Andrasevic, Panagiota Maikanti, Helena Žemličková, Henrik Hasman, Marina Ivanova, Kati Räisänen, Sylvie Maugat, Ines Noll, Kassiani Mellou, Ákos Tóth, Kristján Orri Helgason, Stephen Murchan, Giulia Errico, Ieva Voita, Esther Walser-Domjan, Jolanta Miciulevičienė, Monique Perrin, Elizabeth Anne Scicluna, Sjoukje Hs Woudt, Ørjan Samuelsen, Dorota Żabicka, Manuela Caniça, Gabriel Adrian Popescu, Eva Schréterová, Helena Ribič, Maria Belén Aracil García, Hanna Billström.Bloodstream infections (BSIs) with Acinetobacter species commonly have poor outcomes, especially in intensive care unit (ICU) patients [1]. Acinetobacter spp. is intrinsically resistant to many antimicrobials, and additional acquired resistance further complicates the treatment of serious infections in already vulnerable patient groups. Recent data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) show a large and statistically significant increase in reports of Acinetobacter spp. BSIs in the European Union (EU) and European Economic Area (EEA) during the period from 2017 to 2021 [2]. Most of this increase occurred in 2020 and 2021, the first years of the coronavirus disease (COVID-19) pandemic. Here we further explore this trend in a subset of data from laboratories that continuously reported data during that period.info:eu-repo/semantics/publishedVersio

Decreasing and stabilising trends of antimicrobial consumption and resistance in Escherichia coli and Klebsiella pneumoniae in segmented regression analysis, European Union/European Economic Area, 2001 to 2018

Investments to reduce the spread of antimicrobial resistance (AMR) in the European Union have been made, including efforts to strengthen prudent antimicrobial use. Using segmented regression, we report decreasing and stabilising trends in data reported to the European Surveillance of Antimicrobial Consumption Network and stabilising trends in data reported to the European Antimicrobial Resistance Surveillance Network. Our results could be an early indication of the effect of prioritising AMR on the public health agenda

Penicillin-resistant pneumococci in Sweden : Epidemiology and public health response

Since 1996, all identified cases of pneumococci with a MIC for penicillin G > 0.5 mg/L (penicillin resistant pneumococci: PRP) have been registered according to the Swedish Communicable Disease Act. In the same year, an expert committee appointed by the Swedish Board of Health and Welfare presented an intervention programme with the objective to reduce the spread of resistant pneumococci in Sweden. The recommendations included active control measures in day-care centres, as well as actions against inappropriate use of antibiotics. The aim of this thesis was to describe and analyse the epidemiology of reported Swedish PRP cases, and to describe and analyse the public health response aiming to reduce the spread of PRP in the country. In study I, we describe trends and case characteristics of PRP cases reported according to the Communicable Disease Act between 1997 and 2003. Despite a reduction in the reported PRP incidence by 39 %, the PRP frequency (proportion PRP of all isolated pneumococci) remained stable around 2 % during the period. The reported proportion of PRP resistant to other antibiotics increased, and multi-resistance was common. However, further analysis of PRP case finding activity (study II), indicated that PRP surveillance data might be biased due to both temporal and regional differences in case finding activity. We found that the nasopharyngeal culturing activity was associated with both the pneumococcal and the PRP incidences. Between 1998 and 2003, the reported national nasopharyngeal culturing activity decreased by 31 %. There were also large regional variations, and routines for contact tracing to identify asymptomatic cases differed between the counties. The most common serogroups among reported Swedish PRP cases were in descending order 9, 19, 14, 23 and 6. In study III, we used data from the South Swedish Pneumococcal Intervention Project to estimate the duration of nasopharyngeal PRP carriage, stratified by both serogroup and age of the case. We found that children below the age of 5 years carried PRP for significantly longer periods (mean 43 days, 95% CI 41-45 days) compared with older individuals (mean 25 days, 95% CI 24 27 days). There were also differences within the group of cases below the age of 5 years, as the observed duration of carriage became significantly shorter for each increasing age-step <1 years, 1-2 years and 3-4 years. In addition, cases aged < 5 years carried serogroup 9 and 14 for significantly shorter periods compared with group 6 and 23. Serogroup 9 was also carried for significantly shorter periods compared with group 19 In study IV, we followed the incidence in day care centre groups with ongoing PRP-spread, to evaluate the effect of temporary excluding PRP carrying children, as recommended by the PRP expert committee. All identified carriers were excluded from day care attendance in study area A (Skåne Region) while they remained in the group in study area B (Göteborg and Örebro), according to existing local policies. The relative risk for children to acquire PRP in DCC groups without active intervention (area B) was 6.4 (95% CI 2.0 20.7). Each prevented case in area A was estimated to have demanded the exclusion of 2 other children from day-care for approximately four to five weeks each. In study V, weekly data on the total number of dispensed outpatient antibiotic prescriptions to children aged < 6 years between 1992 and 2003 were examined by time series analysis. No increasing trend segments could be identifies in data. No correlation could be found between the annual antibiotic sales and the resistance levels of reported PRP between 1998 and 2003 in Study I

Age- and Serogroup-Related Differences in Observed Durations of Nasopharyngeal Carriage of Penicillin-Resistant Pneumococci

Using data from an ongoing Swedish intervention project, the observed durations of nasopharyngeal carriage of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) (MIC of penicillin G of ≥0.5 μg/ml) stratified by both pneumococcal serogroup and age of the carrier were compared. The means and 95% confidence intervals (CIs) were estimated by fitting a gamma distribution to the observed duration of carriage for each age and serogroup stratum. The mean observed duration of carriage for all cases was 37 days (95% CI, 35 to 38 days). Children below the age of 5 years carried PNSP for significantly longer periods (43 days; 95% CI, 41 to 45 days) compared with older individuals (25 days; 95% CI, 24 to 27 days). There were also differences within the group of cases below the age of 5 years, as the duration of carriage became significantly shorter for each increasing age step: <1, 1 to 2, and 3 to 4 years. In addition, patients <5 years of age carried serogroups 9 and 14 for significantly shorter periods than groups 6 and 23. Serogroup 9 was also carried for significantly shorter periods than group 19. For patients aged 5 years or older, no significant difference in carriage duration for different ages or serogroups could be noted. As young children have the longest duration of PNSP carriage, interventions aiming to reduce the prevalence in this group are of great importance. The results highlight the importance of taking both serogroup and age of the carriers into account when studying the dynamics of pneumococcal transmission in young children

Decrease in community antibiotic consumption during the COVID-19 pandemic, EU/EEA, 2020

We present a European Union/European Economic Area-wide overview of the changes in consumption of antibacterials for systemic use (ATC J01) in the community between 2019 and 2020 as reported to the European Surveillance of Antimicrobial Consumption Network. Overall antibiotic consumption decreased by 18.3% between 2019 and 2020, the largest annual decrease in the network's two-decade history. We observed a strong association between the level of community antibiotic consumption in 2019 and the size of the decrease between 2019 and 2020

Decreasing and stabilising trends of antimicrobial consumption and resistance in Escherichia coli and Klebsiella pneumoniae in segmented regression analysis, European Union/European Economic Area, 2001 to 2018.

Investments to reduce the spread of antimicrobial resistance (AMR) in the European Union have been made, including efforts to strengthen prudent antimicrobial use. Using segmented regression, we report decreasing and stabilising trends in data reported to the European Surveillance of Antimicrobial Consumption Network and stabilising trends in data reported to the European Antimicrobial Resistance Surveillance Network. Our results could be an early indication of the effect of prioritising AMR on the public health agenda

Variations in the Consumption of Antimicrobial Medicines in the European Region, 2014–2018: Findings and Implications from ESAC-Net and WHO Europe

Background: Surveillance of antimicrobial consumption (AMC) is important to address inappropriate use. AMC data for countries in the European Union (EU) and European Economic Area (EEA) and Eastern European and Central Asian countries were compared to provide future guidance. Methods: Analyses of 2014-2018 data from 30 EU/EEA countries of the European Surveillance of Antibiotic Consumption network (ESAC-Net) and 15 countries of the WHO Regional Office for Europe (WHO Europe) AMC Network were conducted using the Anatomical Therapeutic Chemical (ATC) classification and Defined Daily Dose (DDD) methodology. Total consumption (DDD per 1000 inhabitants per day) of antibacterials for systemic use (ATC group J01), relative use (percentages), trends over time, alignment with the WHO Access, Watch, Reserve (AWaRe) classification, concordance with the WHO global indicator (60% of total consumption should be Access agents), and composition of the drug utilization 75% (DU75%) were calculated. Findings: In 2018, total consumption of antibacterials for systemic use (ATC J01) ranged from 8.9 to 34.1 DDD per 1000 inhabitants per day (population-weighted mean for ESAC-Net 20.0, WHO Europe AMC Network 19.6, ESAC-Net Study Group, and WHO Europe AMC Network Study Group). ESAC-Net countries consumed more penicillins (J01C ; 8.7 versus 6.3 DDD per 1000 inhabitants per day), more tetracyclines (J01A ; 2.2 versus 1.2), less cephalosporins (J01D ; 2.3 versus 3.8) and less quinolones (J01M ; 1.7 versus 3.4) than WHO Europe AMC Network countries. Between 2014 and 2018, there were statistically significant reductions in total consumption in eight ESAC-Net countries. In 2018, the relative population-weighted mean consumption of Access agents was 57.9% for ESAC-Net and 47.4% for the WHO Europe AMC Network. For each year during 2014- 2018, 14 ESAC-Net and one WHO Europe AMC Network countries met the WHO global monitoring target of 60% of total consumption being Access agents. DU75% analyses showed differences in the choices of agents in the two networks. Interpretation: Although total consumption of antibacterials for systemic use was similar in the two networks, the composition of agents varied substantially. The greater consumption of Watch group agents in WHO Europe AMC Network countries suggests opportunities for improved prescribing. Significant decreases in consumption in several ESAC-Net countries illustrate the value of sustained actions to address antimicrobial resistance