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...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
eLife Sciences Publications Ltd
2019-12-01
|
| Series: | eLife |
| Subjects: | |
| Online Access: | https://elifesciences.org/articles/50468 |
| _version_ | 1811180580126064640 |
|---|---|
| author | Thomas Crellen Paul Turner Sreymom Pol Stephen Baker To Nguyen Thi Nguyen Nicole Stoesser Nicholas PJ Day Claudia Turner Ben S Cooper |
| author_facet | Thomas Crellen Paul Turner Sreymom Pol Stephen Baker To Nguyen Thi Nguyen Nicole Stoesser Nicholas PJ Day Claudia Turner Ben S Cooper |
| author_sort | Thomas Crellen |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-11T09:04:29Z |
| format | Article |
| id | doaj.art-f5c9644d81024c0283c908cfd9075adc |
| institution | Directory Open Access Journal |
| issn | 2050-084X |
| language | English |
| last_indexed | 2024-04-11T09:04:29Z |
| publishDate | 2019-12-01 |
| publisher | eLife Sciences Publications Ltd |
| record_format | Article |
| series | eLife |
| spelling | doaj.art-f5c9644d81024c0283c908cfd9075adc2022-12-22T04:32:40ZengeLife Sciences Publications LtdeLife2050-084X2019-12-01810.7554/eLife.50468Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing countryThomas Crellen0https://orcid.org/0000-0003-2934-1063Paul Turner1https://orcid.org/0000-0002-1013-7815Sreymom Pol2https://orcid.org/0000-0001-8393-659XStephen Baker3https://orcid.org/0000-0003-1308-5755To Nguyen Thi Nguyen4Nicole Stoesser5Nicholas PJ Day6Claudia Turner7Ben S Cooper8https://orcid.org/0000-0002-9445-7217Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United KingdomMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, CambodiaMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, CambodiaNuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Viet NamOxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Viet NamNuffield Department of Medicine, University of Oxford, Oxford, United KingdomMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United KingdomMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, CambodiaMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United KingdomMultidrug-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.https://elifesciences.org/articles/50468Klebsiella pneumoniaeantibiotic resistancepathogen genomicscohort studyneonatesSouth East Asia |
| spellingShingle | Thomas Crellen Paul Turner Sreymom Pol Stephen Baker To Nguyen Thi Nguyen Nicole Stoesser Nicholas PJ Day Claudia Turner Ben S Cooper Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country eLife Klebsiella pneumoniae antibiotic resistance pathogen genomics cohort study neonates South East Asia |
| 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 | Klebsiella pneumoniae antibiotic resistance pathogen genomics cohort study neonates South East Asia |
| url | https://elifesciences.org/articles/50468 |
| work_keys_str_mv | AT thomascrellen transmissiondynamicsandcontrolofmultidrugresistantklebsiellapneumoniaeinneonatesinadevelopingcountry AT paulturner transmissiondynamicsandcontrolofmultidrugresistantklebsiellapneumoniaeinneonatesinadevelopingcountry AT sreymompol transmissiondynamicsandcontrolofmultidrugresistantklebsiellapneumoniaeinneonatesinadevelopingcountry AT stephenbaker transmissiondynamicsandcontrolofmultidrugresistantklebsiellapneumoniaeinneonatesinadevelopingcountry AT tonguyenthinguyen transmissiondynamicsandcontrolofmultidrugresistantklebsiellapneumoniaeinneonatesinadevelopingcountry AT nicolestoesser transmissiondynamicsandcontrolofmultidrugresistantklebsiellapneumoniaeinneonatesinadevelopingcountry AT nicholaspjday transmissiondynamicsandcontrolofmultidrugresistantklebsiellapneumoniaeinneonatesinadevelopingcountry AT claudiaturner transmissiondynamicsandcontrolofmultidrugresistantklebsiellapneumoniaeinneonatesinadevelopingcountry AT benscooper transmissiondynamicsandcontrolofmultidrugresistantklebsiellapneumoniaeinneonatesinadevelopingcountry |