Estimating the effect of practicing nursing professionals density on cumulative carbapenem-resistance prevalence in gram-negative invasive Isolates: a 30 European country observational modeling study
Tóm tắt
The burden of antimicrobial-resistance, specifically carbapenem-resistance in gram-negative bacteria (CRGN), presents a serious public health threat worldwide. In Europe, Southern and Eastern countries (SEC) display a higher CRGN-prevalence as compared to Northern and Western countries (NWC). Since SEC also display lower nurse-density on average, we hypothesized that the occurrence of CRGN might correlate with nurse understaffing and therefore aimed at quantifying a potential independent effect of nurse-density on total CRGN in Europe. A 30-country cross-sectional study was conducted. Cumulative six-year CRGN-prevalence (2011–2016) in four gram-negative bacterial species was determined based on > 700 k clinical invasive isolates (EARS-net). We performed multivariable log-linear regression to provide estimations of the effect of nurse-density while adjusting to various health-system variables. Multivariable analysis (adj.-R2 ~ 93%) suggested an average 0.4% [95%-CI 0.2–1.0%] CRGN-increase due to a decrement of one practicing nurse per week of hospital-stay of one population individual. Our modeling provided CRGN-estimations in two non-EARS-net countries (Switzerland and Turkey), which were almost equal to empirically estimated values (CAESAR-Network). Furthermore, a nurse-density-dependent moderation of the inter-species distribution balance was a likely pathway of the observed effect. These observations were specific for CRGN, in contrast to other resistance types in the same species. This is the first attempt of quantifying potential nurse-density effects on antimicrobial-resistance at national level. Our results suggest an increase in CRGN by decreasing nurse-density. Nurse-density is thus a novel factor that might improve our understanding of the unbalanced CRGN-distribution among sub-European regions. Consequently, integrating nurse-density in future AMR-policies could be beneficial.
Tài liệu tham khảo
Harbarth S, Balkhy HH, Goossens H, Jarlier V, Kluytmans J, Laxminarayan R, et al. Antimicrobial resistance: one world, one fight! Antimicrob Resist Infect Control. 2015;4:49. https://doi.org/10.1186/s13756-015-0091-2.
Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014;5:229–41. https://doi.org/10.1177/2042098614554919.
Goossens H, Ferech M, Stichele RV, Elseviers M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365:579–87. https://doi.org/10.1016/S0140-6736(05)17907-0.
McDonnell L, Armstrong D, Ashworth M, Dregan A, Malik U, White P. National disparities in the relationship between antimicrobial resistance and antimicrobial consumption in Europe: an observational study in 29 countries. J Antimicrob Chemother. 2017;72:3199–204. https://doi.org/10.1093/jac/dkx248.
Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA, et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci. 2018;115:E3463–70. https://doi.org/10.1073/pnas.1717295115.
Mueller T, Östergren P-O. The correlation between regulatory conditions and antibiotic consumption within the WHO European Region. Health Policy. 2016;120:882–9. https://doi.org/10.1016/j.healthpol.2016.07.004.
European Centre for Disease Prevention and Control. Antimicrobial resistance in the EU/EEA (EARS-Net)—Annual Epidemiological Report for 2019. Eur Cent Dis Prev Control 2020. https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-resistance-europe-2019. Accessed May 12, 2021
Hansen S, Schwab F, Asensio A, Carsauw H, Heczko P, Klavs I, et al. Methicillin-resistant Staphylococcus aureus (MRSA) in Europe: which infection control measures are taken? Infection. 2010;38:159–64. https://doi.org/10.1007/s15010-010-0001-8.
Collignon P, Athukorala P, Senanayake S, Khan F. Antimicrobial resistance: the major contribution of poor governance and corruption to this growing problem. PLoS ONE. 2015;10: e0116746. https://doi.org/10.1371/journal.pone.0116746.
Rönnerstrand B, Lapuente V. Corruption and use of antibiotics in regions of Europe. Health Policy. 2017;121:250–6. https://doi.org/10.1016/j.healthpol.2016.12.010.
MacFadden DR, McGough SF, Fisman D, Santillana M, Brownstein JS. Antibiotic resistance increases with local temperature. Nat Clim Change. 2018;8:510–4. https://doi.org/10.1038/s41558-018-0161-6.
Kaba HEJ, Kuhlmann E, Scheithauer S. Thinking outside the box: association of antimicrobial resistance with climate warming in Europe—A 30 country observational study. Int J Hyg Environ Health. 2020;223:151–8. https://doi.org/10.1016/j.ijheh.2019.09.008.
McGough SF, MacFadden DR, Hattab MW, Mølbak K, Santillana M. Rates of increase of antibiotic resistance and ambient temperature in Europe: a cross-national analysis of 28 countries between 2000 and 2016. Euro Surveill. 2020. https://doi.org/10.2807/1560-7917.ES.2020.25.45.1900414.
Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019;19:56–66. https://doi.org/10.1016/S1473-3099(18)30605-4.
Ayobami O, Willrich N, Suwono B, Eckmanns T, Markwart R. The epidemiology of carbapenem-non-susceptible Acinetobacter species in Europe: analysis of EARS-Net data from 2013 to 2017. Antimicrob Resist Infect Control. 2020;9:89. https://doi.org/10.1186/s13756-020-00750-5.
OECD, European Union. Health at a Glance: Europe 2020: State of Health in the EU Cycle. OECD; 2020. https://doi.org/10.1787/82129230-en.
Shang J, Needleman J, Liu J, Larson E, Stone PW. Nurse staffing and healthcare-associated infection. Unit-Level Analysis JONA J Nurs Adm. 2019;49:260–5. https://doi.org/10.1097/NNA.0000000000000748.
World Health Organization. Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics 2017. https://www.who.int/medicines/publications/WHO-PPL-Short_Summary_25Feb-ET_NM_WHO.pdf
Michalos AC, editor. International standard classification of occupations (ISCO). Encycl Qual Life Well Res. Dordrecht: Springer; 2014. p. 3336–3336. https://doi.org/10.1007/978-94-007-0753-5_102084.
Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis Off Publ Infect Dis Soc Am. 1997;24:584–602. https://doi.org/10.1093/clind/24.4.584.
Robert J, Fridkin SK, Blumberg HM, Anderson B, White N, Ray SM, et al. The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit. Infect Control Hosp Epidemiol. 2000;21:12–7. https://doi.org/10.1086/501690.
Scheithauer S, Batzer B, Dangel M, Passweg J, Widmer A. Workload even affects hand hygiene in a highly trained and well-staffed setting: a prospective 365/7/24 observational study. J Hosp Infect. 2017;97:11–6. https://doi.org/10.1016/j.jhin.2017.02.013.
Bonten M, Johnson JR, van den Biggelaar AHJ, Georgalis L, Geurtsen J, de Palacios PI, et al. Epidemiology of Escherichia coli bacteremia: a systematic literature review. Clin Infect Dis. 2021;72:1211–9. https://doi.org/10.1093/cid/ciaa210.
Hugonnet S, Chevrolet J-C, Pittet D. The effect of workload on infection risk in critically ill patients. Crit Care Med. 2007;35:76–81. https://doi.org/10.1097/01.CCM.0000251125.08629.3F.
Morgan DJ, Liang SY, Smith CL, Johnson JK, Harris AD, Furuno JP, et al. Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2010;31:716–21. https://doi.org/10.1086/653201.
Thom KA, Rock C, Jackson SS, Johnson JK, Srinivasan A, Magder LS, et al. Factors leading to transmission risk of Acinetobacter baumannii. Crit Care Med. 2017;45:e633–9. https://doi.org/10.1097/CCM.0000000000002318.
Collignon P, Beggs JJ, Walsh TR, Gandra S, Laxminarayan R. Anthropological and socioeconomic factors contributing to global antimicrobial resistance: a univariate and multivariable analysis. Lancet Planet Health. 2018;2:e398-405. https://doi.org/10.1016/S2542-5196(18)30186-4.
European Centre for Disease Prevention and Control. Antimicrobial resistance in the EU/EEA (EARS-Net)—Annual Epidemiological Report for 2016 2017. https://www.ecdc.europa.eu/en/publications-data/antimicrobial-resistance-surveillance-europe-2016 Accessed May 12, 2021.
Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2014;383:1824–30. https://doi.org/10.1016/S0140-6736(13)62631-8.