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BMC Infectious Diseases
Published in:

Open Access 01-12-2022 | Public Health | Research

The impact of public health interventions on the future prevalence of ESBL-producing Klebsiella pneumoniae: a population based mathematical modelling study

Authors: Luisa Salazar-Vizcaya, Andrew Atkinson, Andreas Kronenberg, Catherine Plüss-Suard, Roger D. Kouyos, Viacheslav Kachalov, Nicolas Troillet, Jonas Marschall, Rami Sommerstein

Published in: BMC Infectious Diseases | Issue 1/2022

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Abstract

Background

Future prevalence of colonization with extended-spectrum betalactamase (ESBL-) producing K. pneumoniae in humans and the potential of public health interventions against the spread of these resistant bacteria remain uncertain.

Methods

Based on antimicrobial consumption and susceptibility data recorded during > 13 years in a Swiss region, we developed a mathematical model to assess the comparative effect of different interventions on the prevalence of colonization.

Results

Simulated prevalence stabilized in the near future when rates of antimicrobial consumption and in-hospital transmission were assumed to remain stable (2025 prevalence: 6.8% (95CI%:5.4–8.8%) in hospitals, 3.5% (2.5–5.0%) in the community versus 6.1% (5.0–7.5%) and 3.2% (2.3–4.2%) in 2019, respectively). When overall antimicrobial consumption was set to decrease by 50%, 2025 prevalence declined by 75% in hospitals and by 64% in the community. A 50% decline in in-hospital transmission rate led to a reduction in 2025 prevalence of 31% in hospitals and no reduction in the community. The best model fit estimated that 49% (6–100%) of observed colonizations could be attributable to sources other than human-to-human transmission within the geographical setting.

Conclusions

Projections suggests that overall antimicrobial consumption will be, by far, the most powerful driver of prevalence and that a large fraction of colonizations could be attributed to non-local transmissions.
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Literature
1.
Cassini A, Hogberg LD, Plachouras D, 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(1):56–66.CrossRef
2.
Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013;13(12):1057–98.CrossRef
3.
Holmes AH, Moore LS, Sundsfjord A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016;387(10014):176–87.CrossRef
4.
Zahar JR, Lortholary O, Martin C, et al. Addressing the challenge of extended-spectrum beta-lactamases. Curr Opin Investig Drugs. 2009;10(2):172–80.PubMed
5.
Lee CR, Lee JH, Park KS, et al. Global dissemination of carbapenemase-producing Klebsiella pneumoniae: epidemiology, genetic context, treatment options, and detection methods. Front Microbiol. 2016;7:895.PubMedPubMedCentral
6.
Canton R, Akova M, Carmeli Y, et al. Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clin Microbiol Infect. 2012;18(5):413–31.CrossRef
7.
Skov RL, Monnet DL. Plasmid-mediated colistin resistance (mcr-1 gene): three months later, the story unfolds. Euro Surveill. 2016;21(9).
8.
Van Boeckel TP, Brower C, Gilbert M, et al. Global trends in antimicrobial use in food animals. Proc Natl Acad Sci U S A. 2015;112(18):5649–54.CrossRef
9.
Singer RS, Ward MP, Maldonado G. Can landscape ecology untangle the complexity of antibiotic resistance? Nat Rev Microbiol. 2006;4(12):943–52.CrossRef
10.
MacLean RC, Hall AR, Perron GG, et al. The population genetics of antibiotic resistance: integrating molecular mechanisms and treatment contexts. Nat Rev Genet. 2010;11(6):405–14.CrossRef
11.
12.
13.
Kronenberg A, Hilty M, Endimiani A, et al. Temporal trends of extended-spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolates in in- and outpatients in Switzerland, 2004 to 2011. Euro Surveill. 2013;18(21).
14.
15.
Gasser M, Schrenzel J, Kronenberg A. Aktuelle Entwicklung der Antibiotikaresistenzen in der Schweiz. Swiss Medical Forum. 2018;18(46):943–9.
16.
Harada Y, Morinaga Y, Kaku N, et al. In vitro and in vivo activities of piperacillin-tazobactam and meropenem at different inoculum sizes of ESBL-producing Klebsiella pneumoniae. Clin Microbiol Infect. 2014;20(11):O831–9.CrossRef
17.
Ng TM, Khong WX, Harris PN, et al. Empiric piperacillin-tazobactam versus carbapenems in the treatment of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacteriaceae. PLoS ONE. 2016;11(4): e0153696.CrossRef
18.
Roger PM, Montera E, Lesselingue D, et al. Risk factors for unnecessary antibiotic therapy: a major role for clinical management. Clin Infect Dis. 2018.
19.
Ranjbar R, Masoudimanesh M, Dehkordi FS, et al. Shiga (Vero)-toxin producing Escherichia coli isolated from the hospital foods; virulence factors, o-serogroups and antimicrobial resistance properties. Antimicrob Resist Infect Control. 2017;6:4.CrossRef
20.
George A. Antimicrobial resistance, trade, food safety and security. One health. 2018;5:6–8.CrossRef
21.
Marder EP, Cieslak PR, Cronquist AB, et al. Incidence and trends of infections with pathogens transmitted commonly through food and the effect of increasing use of culture-independent diagnostic tests on surveillance—foodborne diseases active surveillance network, 10 U.S. Sites, 2013–2016. MMWR Morb Mortal Wkly Rep. 2017;66(15):397–403.CrossRef
22.
Hassing RJ, Alsma J, Arcilla MS, et al. International travel and acquisition of multidrug-resistant Enterobacteriaceae: a systematic review. Euro Surveill. 2015;20(47).
23.
Reuland EA, Sonder GJ, Stolte I, et al. Travel to Asia and traveller’s diarrhoea with antibiotic treatment are independent risk factors for acquiring ciprofloxacin-resistant and extended spectrum beta-lactamase-producing Enterobacteriaceae-a prospective cohort study. Clin Microbiol Infect. 2016;22(8):731.CrossRef
24.
Kantele A, Laaveri T, Mero S, et al. Antimicrobials increase travelers’ risk of colonization by extended-spectrum betalactamase-producing Enterobacteriaceae. Clin Infect Dis. 2015;60(6):837–46.CrossRef
25.
R Core Team (2014). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria.
26.
Soetaert K, Petzoldt T, Setzer R. deSolve: General Solvers for Initial Value Problems of Ordinary Differential Equations (ODE), Partial Differential Equations (PDE), Differential Algebraic Equations (DAE), and Delay Differential Equations (DDE). Secondary deSolve: General Solvers for Initial Value Problems of Ordinary Differential Equations (ODE), Partial Differential Equations (PDE), Differential Algebraic Equations (DAE), and Delay Differential Equations (DDE). http://​cran.​r-project.​org/​web/​packages/​deSolve/​index.​html.
27.
28.
29.
Alvarez-Uria G, Gandra S, Mandal S, et al. Global forecast of antimicrobial resistance in invasive isolates of Escherichia coli and Klebsiella pneumoniae. Int J Infect Dis. 2018;68:50–3.CrossRef
30.
Hilty M, Betsch BY, Bogli-Stuber K, et al. Transmission dynamics of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting. Clin Infect Dis. 2012;55(7):967–75.CrossRef
31.
Struelens MJ, Sintchenko V. Editorial: pathogen genomics: empowering infectious disease surveillance and outbreak investigations. Front Public Health. 2020;8:179.CrossRef
32.
van Duijkeren E, Wielders CCH, Dierikx CM, et al. Long-term carriage of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in the general population in The Netherlands. Clin Infect Dis. 2018;66(9):1368–76.CrossRef
33.
Reuland EA, Al Naiemi N, Raadsen SA, et al. Prevalence of ESBL-producing Enterobacteriaceae in raw vegetables. Eur J Clin Microbiol Infect Dis. 2014;33(10):1843–6.CrossRef
34.
Wilson APR. Sparing carbapenem usage. J Antimicrob Chemother. 2017;72(9):2410–7.CrossRef
35.
Lew KY, Ng TM, Tan M, et al. Safety and clinical outcomes of carbapenem de-escalation as part of an antimicrobial stewardship programme in an ESBL-endemic setting. J Antimicrob Chemother. 2015;70(4):1219–25.CrossRef
36.
Obolski U, Stein GY, Hadany L. Antibiotic restriction might facilitate the emergence of multi-drug resistance. PLoS Comput Biol. 2015;11(6): e1004340.CrossRef
37.
Nichol D, Jeavons P, Fletcher AG, et al. Steering evolution with sequential therapy to prevent the emergence of bacterial antibiotic resistance. PLoS Comput Biol. 2015;11(9): e1004493.CrossRef
38.
Sypsa V, Psichogiou M, Bouzala GA, et al. Transmission dynamics of carbapenemase-producing Klebsiella pneumoniae and anticipated impact of infection control strategies in a surgical unit. PLoS ONE. 2012;7(7): e41068.CrossRef
39.
Friedmann R, Raveh D, Zartzer E, et al. Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization. Infect Control Hosp Epidemiol. 2009;30(6):534–42.CrossRef
40.
Harris AD, Perencevich EN, Johnson JK, et al. Patient-to-patient transmission is important in extended-spectrum beta-lactamase-producing Klebsiella pneumoniae acquisition. Clin Infect Dis. 2007;45(10):1347–50.CrossRef
41.
Aldeyab MA, Harbarth S, Vernaz N, et al. The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum beta-lactamase-producing bacteria in primary and secondary healthcare settings. Br J Clin Pharmacol. 2012;74(1):171–9.CrossRef
42.
Piroth L, Aube H, Doise JM, et al. Spread of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: are beta-lactamase inhibitors of therapeutic value? Clin Infect Dis. 1998;27(1):76–80.CrossRef
43.
Jorgensen SB, Soraas A, Sundsfjord A, et al. Fecal carriage of extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae after urinary tract infection—a three year prospective cohort study. PLoS ONE. 2017;12(3): e0173510.CrossRef
44.
Tham J, Walder M, Melander E, et al. Duration of colonization with extended-spectrum beta-lactamase-producing Escherichia coli in patients with travellers’ diarrhoea. Scand J Infect Dis. 2012;44(8):573–7.CrossRef
45.
Arcilla MS, van Hattem JM, Haverkate MR, et al. Import and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study. Lancet Infect Dis. 2017;17(1):78–85.CrossRef
46.
Suetens C, Latour K, Karki T, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46).
47.
Magill SS, O’Leary E, Janelle SJ, et al. Changes in prevalence of health care-associated infections in U.S. Hospitals. N Engl J Med. 2018;379(18):1732–44.CrossRef
Metadata
Title
The impact of public health interventions on the future prevalence of ESBL-producing Klebsiella pneumoniae: a population based mathematical modelling study
Authors
Luisa Salazar-Vizcaya
Andrew Atkinson
Andreas Kronenberg
Catherine Plüss-Suard
Roger D. Kouyos
Viacheslav Kachalov
Nicolas Troillet
Jonas Marschall
Rami Sommerstein
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-022-07441-z

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