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Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country
Multidrug-resistant Klebsiella pneumoniae is an increasing cause of infant mortality in developing countries. We aimed to develop a quantitative understanding of the drivers of this epidemic by estimating the effects of antibiotics on nosocomial transmission risk, comparing competing hypotheses abou...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
eLife Sciences Publications, Ltd
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977969/ https://www.ncbi.nlm.nih.gov/pubmed/31793878 http://dx.doi.org/10.7554/eLife.50468 |
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author | Crellen, Thomas Turner, Paul Pol, Sreymom Baker, Stephen Nguyen Thi Nguyen, To Stoesser, Nicole Day, Nicholas PJ Turner, Claudia Cooper, Ben S |
author_facet | Crellen, Thomas Turner, Paul Pol, Sreymom Baker, Stephen Nguyen Thi Nguyen, To Stoesser, Nicole Day, Nicholas PJ Turner, Claudia Cooper, Ben S |
author_sort | Crellen, Thomas |
collection | PubMed |
description | Multidrug-resistant Klebsiella pneumoniae is an increasing cause of infant mortality in developing countries. We aimed to develop a quantitative understanding of the drivers of this epidemic by estimating the effects of antibiotics on nosocomial transmission risk, comparing competing hypotheses about mechanisms of spread, and quantifying the impact of potential interventions. Using a sequence of dynamic models, we analysed data from a one-year prospective carriage study in a Cambodian neonatal intensive care unit with hyperendemic third-generation cephalosporin-resistant K. pneumoniae. All widely-used antibiotics except imipenem were associated with an increased daily acquisition risk, with an odds ratio for the most common combination (ampicillin + gentamicin) of 1.96 (95% CrI 1.18, 3.36). Models incorporating genomic data found that colonisation pressure was associated with a higher transmission risk, indicated sequence type heterogeneity in transmissibility, and showed that within-ward transmission was insufficient to maintain endemicity. Simulations indicated that increasing the nurse-patient ratio could be an effective intervention. |
format | Online Article Text |
id | pubmed-6977969 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | eLife Sciences Publications, Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-69779692020-01-27 Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country Crellen, Thomas Turner, Paul Pol, Sreymom Baker, Stephen Nguyen Thi Nguyen, To Stoesser, Nicole Day, Nicholas PJ Turner, Claudia Cooper, Ben S eLife Epidemiology and Global Health Multidrug-resistant Klebsiella pneumoniae is an increasing cause of infant mortality in developing countries. We aimed to develop a quantitative understanding of the drivers of this epidemic by estimating the effects of antibiotics on nosocomial transmission risk, comparing competing hypotheses about mechanisms of spread, and quantifying the impact of potential interventions. Using a sequence of dynamic models, we analysed data from a one-year prospective carriage study in a Cambodian neonatal intensive care unit with hyperendemic third-generation cephalosporin-resistant K. pneumoniae. All widely-used antibiotics except imipenem were associated with an increased daily acquisition risk, with an odds ratio for the most common combination (ampicillin + gentamicin) of 1.96 (95% CrI 1.18, 3.36). Models incorporating genomic data found that colonisation pressure was associated with a higher transmission risk, indicated sequence type heterogeneity in transmissibility, and showed that within-ward transmission was insufficient to maintain endemicity. Simulations indicated that increasing the nurse-patient ratio could be an effective intervention. eLife Sciences Publications, Ltd 2019-12-03 /pmc/articles/PMC6977969/ /pubmed/31793878 http://dx.doi.org/10.7554/eLife.50468 Text en © 2019, Crellen et al http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use and redistribution provided that the original author and source are credited. |
spellingShingle | Epidemiology and Global Health Crellen, Thomas Turner, Paul Pol, Sreymom Baker, Stephen Nguyen Thi Nguyen, To Stoesser, Nicole Day, Nicholas PJ Turner, Claudia Cooper, Ben S Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country |
title | Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country |
title_full | Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country |
title_fullStr | Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country |
title_full_unstemmed | Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country |
title_short | Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country |
title_sort | transmission dynamics and control of multidrug-resistant klebsiella pneumoniae in neonates in a developing country |
topic | Epidemiology and Global Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977969/ https://www.ncbi.nlm.nih.gov/pubmed/31793878 http://dx.doi.org/10.7554/eLife.50468 |
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