Modelling of the transmission dynamics of carbapenem-resistant Klebsiella pneumoniae in hospitals and design of control strategies

Suttikiat Changruenngam,Charin Modchang,Dominique J. Bicout

doi:10.1038/s41598-022-07728-w

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a major threat to global public health. Epidemiological and infection controls associated with CRKP are challenging because of several potential elements involved in a complicated cycle of transmission. Here, we proposed a comprehensive mathematical model to investigate the transmission dynamics of CRKP, determine factors affecting the prevalence, and evaluate the impact of interventions on transmission. The model includes the essential compartments, which are uncolonized, asymptomatic colonized, symptomatic colonized, and relapsed patients. Additionally, symptomatic colonized and relapsed patients were further classified into subpopulations according to their number of treatment failures or relapses. We found that the admission of colonized patients and use of antibiotics significantly impacted the endemic transmission in health care units. Thus, we introduced the treatment efficacy, defined by combining the treatment duration and probability of successful treatment, to characterize and describe the effects of antibiotic treatment on transmission. We showed that a high antibiotic treatment efficacy results in a significantly reduced likelihood of patient readmission in the health care unit. Additionally, our findings demonstrate that CRKP transmission with different epidemiological characteristics must be controlled using distinct interventions.

Highlights

Klebsiella pneumoniae (KP), a Gram-negative bacterium, is a member of the Klebsiella genus of Enterobacteriaceae
We fundamentally examined the impact of admission of colonized patients on the endemic prevalence of Carbapenem-resistant Klebsiella pneumoniae (CRKP) and assessed the effect of antibiotic treatment on transmission
Because asymptomatic colonized patients cannot be identified without active surveillance, they are, treated as ordinary patients as if they were not colonized by CRKP

Summary

Introduction

Klebsiella pneumoniae (KP), a Gram-negative bacterium, is a member of the Klebsiella genus of Enterobacteriaceae. Carbapenem-resistant Klebsiella pneumoniae was originally reported in the United States during the late 1990s9,10 Since it has rapidly disseminated across countries and continents such as Canada, the UK, Spain, France, and I ndia[4]. Treatment of infections associated with CRKP is problematic with extremely high failure rates, resulting in an increase in the hospital length of s tay[24–27]. The isolation of colonized patients, hand hygiene compliance and contact precautions were interventions concerned in their models to assess the impact of measures to control the spread. None of those studies considered the effect of antibiotic treatment on epidemics. To examine the sophisticated mechanism underlying CRKP transmission, the attributable components corresponding to the dissemination of CRKP must be incorporated into the model

Methods

Results

Conclusion