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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Medicine 1/2018

Quantifying where human acquisition of antibiotic resistance occurs: a mathematical modelling study

Zeitschrift:
BMC Medicine > Ausgabe 1/2018
Autoren:
Gwenan M. Knight, Céire Costelloe, Sarah R. Deeny, Luke S. P. Moore, Susan Hopkins, Alan P. Johnson, Julie V. Robotham, Alison H. Holmes
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12916-018-1121-8) contains supplementary material, which is available to authorized users.

Abstract

Background

Antibiotic-resistant bacteria (ARB) are selected by the use of antibiotics. The rational design of interventions to reduce levels of antibiotic resistance requires a greater understanding of how and where ARB are acquired. Our aim was to determine whether acquisition of ARB occurs more often in the community or hospital setting.

Methods

We used a mathematical model of the natural history of ARB to estimate how many ARB were acquired in each of these two environments, as well as to determine key parameters for further investigation. To do this, we explored a range of realistic parameter combinations and considered a case study of parameters for an important subset of resistant strains in England.

Results

If we consider all people with ARB in the total population (community and hospital), the majority, under most clinically derived parameter combinations, acquired their resistance in the community, despite higher levels of antibiotic use and transmission of ARB in the hospital. However, if we focus on just the hospital population, under most parameter combinations a greater proportion of this population acquired ARB in the hospital.

Conclusions

It is likely that the majority of ARB are being acquired in the community, suggesting that efforts to reduce overall ARB carriage should focus on reducing antibiotic usage and transmission in the community setting. However, our framework highlights the need for better pathogen-specific data on antibiotic exposure, ARB clearance and transmission parameters, as well as the link between carriage of ARB and health impact. This is important to determine whether interventions should target total ARB carriage or hospital-acquired ARB carriage, as the latter often dominated in hospital populations.
Zusatzmaterial
Additional file 1: Additional information: Model equations and details of parameterisation. Additional results: Proportion of the population in hospital, variation in infection and mortality rates, histogram of parameter sets, sensitivity analyses. (PDF 177 kb)
12916_2018_1121_MOESM1_ESM.pdf
Literatur
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