Work

Estimating the number and incidence of carbapenemase-producing Enterobacterales infections in France in 2020: A capture-recapture study

Year: 2024

Type: article

Abstract: • 1722 carbapenemase-producing Enterobacterales (CPE) clinical isolates reported in 2020 in France through three monitoring systems. • We estimated at 3287 [CI 95% 1566–6096] the total number of CPE infections in France. • Estimated incidence was 0.031 CPE/1000 hospital-days [CI 95% 0.015–0.057/1000 hospital-days]. • Concerning this rare event, passive surveillance from voluntary hospitals does not adequately reflect actual epidemiology. • Recommendations: Maintaining an early warning system and the National Reference Centre, and improving participation in the national surveillance. Even though France faces few severe infections due to carbapenem-producing Enterobacterales (CPE), inter-regional epidemic stages render their dissemination a cause for considerable concern. CPE reporting relies in France on three non-exhaustive monitoring systems (MS): an early-alert system, a nationwide passive surveillance system and the National Reference Centre. We aim to estimate the number and incidence of CPE-related infections in France in 2020 and to identify any overlap between the three systems to determine whether their continued use still serves a purpose. Data on clinical CPE isolates in 2020 were extracted from the three MS databases. Screening samples were excluded. Datasets were manually merged, isolate by isolate, so as to identify in which system(s) each isolate was reported. A system-participant was defined as any declarant reporting at least one isolate in an MS. Using our matched dataset, we performed Bayesian model averaging for capture-recapture estimations. All in all, 1722 CPE isolates were reported through the monitoring systems in 2020. We estimated that the number of CPE infections was almost twice this number, corresponding to incidence of 0.031 CPE/1000 hospital-days [CI95% 0.015–0.057/1,000 hospital-days], with regional disparities taken into account. Among participating the laboratories, 86% were involved in only one of the systems. Among clinical CPE isolates, 56% were isolated from urine. Regarding this rare infection, surveillance based only on passive surveillance from voluntary hospitals does not reflect actual epidemiology. We recommend maintaining the three monitoring systems and improving the participation of hospitals’ nationwide surveillance, the objective being to more accurately capture the real incidence of CPE infections.

Source: Infectious Diseases Now

DOI: 10.1016/j.idnow.2024.105016