Abstract
Antimicrobial resistance (AMR) is a global threat. A better understanding of how antibiotic use and between-ward patient transfers (or connectivity) impact population-level AMR in hospital networks can help optimize antibiotic stewardship and infection control strategies. Here, we used a metapopulation framework to explain variations in the incidence of infections caused by seven major bacterial species and their drug-resistant variants in a network of 357 hospital wards. We found that ward-level antibiotic consumption volume had a stronger influence on the incidence of the more resistant pathogens, while connectivity had the most influence on hospital-endemic species and carbapenem-resistant pathogens. Piperacillin-tazobactam consumption was the strongest predictor of the cumulative incidence of infections resistant to empirical sepsis therapy. Our data provide evidence that both antibiotic use and connectivity measurably influence hospital AMR. Finally, we provide a ranking of key antibiotics by their estimated population-level impact on AMR that might help inform antimicrobial stewardship strategies.
Highlights
To cite this version: Julie Shapiro, Gilles Leboucher, Anne-Florence Myard-Dury, Pascale Girardo, Anatole Luzatti, et al
Ward-level data were aggregated from 14,034 infection episodes, defined as ward admissions with ≥1 clinical sample positive for E. coli or an ESKAPE pathogen (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter cloacae complex), collectively termed ESKAPE2
Pathogens were grouped into speciesresistance pattern combinations, namely 3rdgeneration cephalosporin-resistant E. coli, E. cloacae complex and K. pneumoniae (3GCREC, -EB and -KP), carbapenem-resistant E. coli, E. cloacae complex, K. pneumoniae, P. aeruginosa and A. baumannii (CREC, -EB, -KP, -PA and -AB), vancomycin-resistant E. faecium (VREF) and methicillin-resistant S. aureus (MRSA)
Summary
To cite this version: Julie Shapiro, Gilles Leboucher, Anne-Florence Myard-Dury, Pascale Girardo, Anatole Luzatti, et al. We used metapopulation modeling to isolate the effect of antibiotic consumption on the incidence of infections with 7 major pathogen species and their resistant variants within a 5,400-bed, 357-ward hospital network, using detailed data over the course of one year.
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