High Antimicrobial Consumption, Low Reported Infection Rates: An Ecological Analysis of HAI Surveillance Discordance...

Area of Science:

• Public Health and Epidemiology
• Infectious Disease Surveillance
• Antimicrobial Resistance

Background:

• Healthcare-associated infections (HAI) are a significant burden in EU/EEA hospitals, with wide variations in reported prevalence.
• Discrepancies exist between low reported HAI rates and high antimicrobial consumption in countries like Romania.
• Existing surveillance methods may not fully capture the true HAI burden across member states.

Purpose of the Study:

• To investigate if antimicrobial consumption data can validate reported HAI prevalence across EU/EEA countries.
• To identify potential inconsistencies in HAI surveillance data using antimicrobial consumption as a cross-check.
• To discuss implications for European funding mechanisms and surveillance frameworks.

Main Methods:

• Cross-sectional ecological analysis of data from 26 EU/EEA countries.
• Utilized HAI prevalence data from ECDC Point Prevalence Survey (2022-2023) and antimicrobial consumption indicators from ESAC-Net (2023).
• Employed statistical methods including correlation, multiple linear regression, bootstrap resampling, and k-means cluster analysis.

Main Results:

• No significant association was found between antimicrobial consumption indicators and reported HAI prevalence.
• Romania and Bulgaria were identified as outliers with high antimicrobial consumption inconsistent with low reported HAI rates.
• Cluster analysis revealed a group with high antimicrobial use and low HAI prevalence, distinct from other EU/EEA countries.

Conclusions:

• The findings suggest potential surveillance underreporting of HAI, particularly in Romania and Bulgaria.
• Antimicrobial consumption, especially broad-spectrum antibiotic use, may serve as a proxy for HAI burden where surveillance is incomplete.
• Policy recommendations include integrating antimicrobial consumption into surveillance frameworks and investing in surveillance reform for effective infection prevention.