OBJECTIVES: Hospitalizations caused by infections with multiresistant gramnegative bacteria (in Germany 3 or 4MRGN) are of growing relevance also in the context of HTA for Ceftazidim Avibactam (CAZ/AVI). CAZ/AVI is part of the WHO reserve antibiotics group and is used in patients with 4MRGN infections. An extensive analysis using different data sources was performed to determine a realistic number of patients and hospital cases with these infections in Germany.

METHODS: Subtypes of 4MRGN bacteria are coded in ICD-10 GM since 2017 following KRINKO/EUCAST classification. Data from two partial surveys (Deutsche Analysedatenbank - DADB, InMED Benchmarking database – BM-DB) and from the German statistics office (Destatis) were collected for 2019. The indications for CAZ/AVI were coded in ICD-10 and cases with both an infectious indication and 4MRGN were analysed. Patients with other infections but a 4MRGN pathogen present were added to the potential numbers. Carrier status was not counted. In-hospital mortality was examined for all indications of CAZ/AVI and the totals were extrapolated to the statutory health insurance (SHI) and the overall German population.

RESULTS: Extrapolations from DADB resulted in 4,408 patients with 4,950 cases, BM-DB resulted in 9,083 cases in German SHI population. This results in 5,022 patients with 5,629 cases (DADB) and 10,348 cases (BM-DB) estimated for the whole population (6.0 to 12.5 cases per 100,000). In-hospital mortality was 18.6% in DADB and 16.0% in the BM-DB population, respectively. In cases with additional bloodstream infections, DADB mortality was correspondingly higher at 33.0%. DADB data showed an incremental mortality increase of 5.7% after 30 days and 10.0% after 90 days resulting in a cumulative 90-day mortality of 34.3%.

CONCLUSIONS: Infections with 4MRGN pathogens in Germany are rare but have a high mortality. The use of different data sources enabled a methodical comparison and derivation of potential analytical benefit for future calculations.