Burden BMR Study: Estimating the Burden of Multidrug-Resistant Bacterial Infections in France.

The Burden BMR study conducted by Santé publique France in 2014–2015 aimed to estimate the public health burden (morbidity, mortality) of MDR infections in France. Seven MDR pathogens were selected for this study: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, Escherichia coli and Klebsiella pneumoniae resistant to third-generation cephalosporins (3GC), K. pneumoniae, Acinetobacter spp., and carbapenem-resistant Pseudomonas aeruginosa. The incidence of invasive infections caused by these MRIs (EARS-Net data, 2012) was adjusted and extrapolated to other infection sites, and mortality attributable to these infections was estimated using ratios from the literature. Methods and parameters were critically reviewed by a group of experts. The study reports that in France, 158,000 (127,000 to 245,000) MRB infections occurred in 2012, including nearly 16,000 invasive infections. MRSA and C3G-resistant Enterobacteriaceae were responsible for 119,000 (90,000 to 172,000) infections, or 75% (70% to 75%) of the total. The number of deaths attributed to these infections was 12,500 (11,500 to 17,500), including 2,700 related to invasive infections. This study provides the first estimate of the burden of MDR infections in France and confirms that MRSA and C3G-resistant Enterobacteriaceae infections account for the largest share. This study highlights the need to strengthen sustained efforts to address this issue.

Colomb-Cotinat M, Lacoste J, Brun-Buisson C, Jarlier V, Coignard B, Vaux S. Estimating the morbidity and mortality associated with infections due to multidrug-resistant bacteria (MDRB), France, 2012. Antimicrobial Resistance & Infection Control 2016.

Colomb-Cotinat M, Lacoste J, Coignard B, Vaux S, Brun-Buisson C, Jarlier V. Morbidity and mortality of infections caused by multidrug-resistant bacteria in France in 2012. Burden BMR Study, report – June 2015. Saint-Maurice: Institute for Public Health Surveillance, 2015. 21 p.

Druti Study

The Druti study (Urinary tract infections caused by antibiotic-resistant bacteria diagnosed in primary care) was conducted in 2012 in collaboration with the Sentinelles network. It estimated the incidence of women with a urinary tract infection (UTI) caused by fluoroquinolone-resistant E. coli and C3G-resistant E. coli per 100 women consulting a general practitioner for suspected UTI over the course of a year. It showed that true community-acquired UTIs caused by C3G-resistant E. coli or ESBL-producing E. coli are rare in France and that their spread remains primarily a hospital-related issue. The study also includes a section on risk factors for UTIs caused by FQ-resistant E. coli and a socio-economic section to better guide the prevention of these infections. These various components are currently being analyzed. Study conducted as part of the partnership between the Sentinelles Network and Santé publique France.

Rossignol L, Maugat S, Blake A, Vaux S, Heym B, Le Strat Y, Kernéis S, Blanchon T, Coignard B, Hanslik T. Risk factors for resistance in urinary tract infections in women in general practice: A cross-sectional survey. J Infect. 2015 Sep,71(3):302-11. doi: 10.1016/j.jinf.2015.05.012. Epub 2015 Jun 6.

Blake A, Rossignol L, Maugat S, Vaux S, Heym B, Le Strat Y, Blanchon T, Hanslik T, Coignard B. DRUTI (Drug Resistance in Community Urinary Tract Infections): Antibiotic resistance in community-acquired urinary tract infections, France, 2012. Oral Presentation at the 33rd Interdisciplinary Meeting on Anti-infective Chemotherapy (RICAI). November 21–22, 2013, Paris

ENP

National surveys on the prevalence of nosocomial infections, conducted every 5 years since 1996, provide an opportunity to extensively document the antibiotic resistance profiles of certain bacterial species isolated from nosocomial infections. Since 2001, they have also provided an opportunity to collect data on antibiotic prescriptions on a given day across a large number of French healthcare facilities. In 2017, the prevalence of patients treated with antibiotics was 15.12%. It has remained stable at around 15–16% across surveys and varies by medical specialty and type of healthcare facility.

National Surveys on the Prevalence of Healthcare-Associated Infections

Labville

In France, nearly 90% of human antibiotic consumption is related to infections diagnosed and treated in outpatient settings. This creates selective pressure that promotes the emergence and spread of bacterial resistance to antibiotics. To complement the French antibiotic resistance surveillance system, which relies primarily on healthcare facility laboratories, Santé publique France collaborated from 2000 to 2009 with a network of private clinical laboratories (LABM), known as the Labville network. The Labville network included 69 LABMs spread across metropolitan France and selected at random to be representative of the national private microbiology sector. Its objective was to continuously and sustainably monitor antibiotic susceptibility in the most common bacterial infections encountered in community practice. This pilot program ended in 2009 due to technical limitations.

This network served as the basis

• for a pilot study aimed at testing the feasibility of extracting data from LABMs, importing it into a standardized database at Santé publique France, and analyzing the data for epidemiological purposes,

• a survey estimating the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in French clinical laboratories (LABMs) and the proportion of strains producing Panton-Valentin leukocidin (PVL),

• testing of an IT solution for the automated transfer to Santé publique France of bacteriology test results processed by the network’s medical testing laboratories.

List of publications and presentations

HALT

National prevalence survey in residential care facilities for dependent elderly people (Ehpad) – HALT 2010 Survey

Thiolet JM, Lejeune B, Coignard B. National prevalence survey in long-term care facilities for the elderly (HALT), France, June–September 2010. Results. Oral presentations. 22nd Congress of the French Society of Hospital Hygiene, Lyon, June 9, 2011.

Prev'Ehpad: 2016 National Survey on the Prevalence of Healthcare-Associated Infections and Antibiotic Treatment in Nursing Homes

The 2015 National Action Program for the Prevention of Healthcare-Associated Infections (Propias), issued by the DGOS/DGS/DGCS directive of June 15, 2015, calls for a national prevalence survey of healthcare-associated infections in long-term care facilities every 5 years. The first national prevalence survey focused on nursing homes. It took place on a specific day between May 16 and June 30, 2016.

Its objectives were to:

• measure the prevalence of targeted infections and antibiotic treatments prescribed to residents in nursing homes in France

• describe the main characteristics of nursing homes, the resident population, the targeted infections identified, and the antibiotic treatments prescribed to residents.

Learn more:

Full report published in October 2017

Survey methodology available at the URL: /Thematic-Files/Infectious-Diseases/Healthcare-Associated-Infections/Surveillance-of-Healthcare-Associated-Infections-HAI/Prevalence-Surveillance Prev'EHPAD 2016 tab