Close proximity interactions support transmission of ESBL-K. pneumoniae but not ESBL-E. coli in healthcare settings

被引：29

作者：

Duval, Audrey ^{[1
]}

Obadia, Thomas ^{[2
,3
,12
]}

Boelle, Pierre-Yves ^{[4
]}

Fleury, Eric ^{[5
,14
]}

Herrmann, Jean-Louis ^{[6
,7
]}

Guillemot, Didier ^{[1
]}

Temime, Laura ^{[8
,9
]}

Opatowski, Lulla ^{[1
]}

Alvarez, Anne Sophie ^{[10
]}

Baraffe, Audrey ^{[10
]}

Beiro, Mariano ^{[11
]}

Bertucci, Inga ^{[10
]}

Boelle, Pierre-Yves ^{[4
]}

Cyncynatus, Camille ^{[13
]}

Dannet, Florence ^{[10
]}

Delaby, Marie Laure ^{[10
,12
]}

Denys, Pierre ^{[10
]}

de Celles, Matthieu Domenech ^{[12
]}

Fleury, Eric ^{[5
,14
]}

Fraboulet, Antoine ^{[15
]}

Gaillard, Jean-Louis ^{[13
]}

Labrador, Boris ^{[10
]}

Lasley, Jennifer ^{[16
]}

Lawrence, Christine ^{[10
]}

Legrand, Judith ^{[17
]}

Le Minor, Odile ^{[18
]}

Ligier, Caroline ^{[18
]}

Martinet, Lucie ^{[19
]}

Mignon, Karine ^{[13
]}

Sacleux, Catherine ^{[10
]}

Salomon, Jerome ^{[20
]}

Obadia, Thomas ^{[2
,3
,12
]}

Perard, Marie ^{[10
]}

Petit, Laure ^{[18
]}

Remy, Laeticia ^{[18
]}

Thiebaut, Anne ^{[16
]}

Thomas, Damien ^{[13
]}

Tronchet, Philippe ^{[10
]}

Villain, Isabelle ^{[10
]}

机构：

[1] Univ Versailles St Quentin, Inst Pasteur, INSERM, Equipe PheMI,Unite B2PHI, Paris, France

[2] Inst Pasteur, Malaria Parasites & Hosts Unit, Dept Parasites & Insect Vectors, Paris, France

[3] Inst Pasteur, CNRS, Bioinformat & Biostat Hub, C3BI,USR 3756 IP, Paris, France

[4] Sorbonne Univ, INSERM, Inst Pierre Louis Epidemiol & Sante Publ, Paris, France

[5] UCB Lyon 1, Univ Lyon, CNRS, ENS Lyon,Inria,LIP,UMR 5668, Lyon, France

[6] Versailles St Quentin Univ, INSERM, U1173, UFR Simone Veil, St Quentin En Yvelines, France

[7] Hop Raymond Poincare, AP HP, Microbiol Serv, Garches, France

[8] Conservatoire Natl Arts & Metiers, Lab MESuRS, Paris, France

[9] Inst Pasteur, Cnam, Unite PACRI, Paris, France

[10] AP HP, Paris, France

[11] Univ Buenos Aires, Buenos Aires, DF, Argentina

[12] Univ Paris 06, Paris, France

[13] AbAg, Chilly Mazarin, France

[14] ENS Lyon, Lyon, France

[15] INSA Lyon, Lyon, France

[16] INSERM, Paris, France

[17] Univ Paris Sud, Orsay, France

[18] Inst Pasteur, Paris, France

[19] INRIA, Lyon, France

[20] Cnam, Paris, France

来源：

PLOS COMPUTATIONAL BIOLOGY | 2019年 / 15卷 / 05期

关键词：

SPECTRUM BETA-LACTAMASE; RESISTANT STAPHYLOCOCCUS-AUREUS; TO-PATIENT TRANSMISSION; ESCHERICHIA-COLI; CONTACT PRECAUTIONS; KLEBSIELLA-PNEUMONIAE; NURSING-HOMES; ENTEROBACTERIACEAE; SPREAD; COLONIZATION;

D O I：

10.1371/journal.pcbi.1006496

中图分类号：

Q5 [生物化学];

学科分类号：

071010 ; 081704 ;

摘要：

Antibiotic-resistance of hospital-acquired infections is a major public health issue. The worldwide emergence and diffusion of extended-spectrum -lactamase (ESBL)-producing Enterobacteriaceae, including Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), is of particular concern. Preventing their nosocomial spread requires understanding their transmission. Using Close Proximity Interactions (CPIs), measured by wearable sensors, and weekly ESBL-EC-and ESBL-KP-carriage data, we traced their possible transmission paths among 329 patients in a 200-bed long-term care facility over 4 months. Based on phenotypically defined resistance profiles to 12 antibiotics only, new bacterial acquisitions were tracked. Extending a previously proposed statistical method, the CPI network's ability to support observed incident-colonization episodes of ESBL-EC and ESBL-KP was tested. Finally, mathematical modeling based on our findings assessed the effect of several infection-control measures. A potential infector was identified in the CPI network for 80% (16/20) of ESBL-KP acquisition episodes. The lengths of CPI paths between ESBL-KP incident cases and their potential infectors were shorter than predicted by chance (P = 0.02), indicating that CPI-network relationships were consistent with dissemination. Potential ESBL-EC infectors were identified for 54% (19/35) of the acquisitions, with longer-than-expected lengths of CPI paths. These contrasting results yielded differing impacts of infection control scenarios, with contact reduction interventions proving less effective for ESBL-EC than for ESBL-KP. These results highlight the widely variable transmission patterns among ESBL-producing Enterobacteriaceae species. CPI networks supported ESBL-KP, but not ESBL-EC spread. These outcomes could help design more specific surveillance and control strategies to prevent in-hospital Enterobacteriaceae dissemination. Author summary Tracing extended-spectrum -lactamase (ESBL) dissemination in hospitals is an important step in the fight against the spread of multi-drug resistant bacteria. Indeed, understanding ESBL spreading dynamics will help identify efficient control interventions. In the i-Bird study, patients and hospital staff from a French long-term care facility carried a wearable sensor to capture their interactions at less than 1.5 meters, every 30 seconds over a 4-month period. Every week, patients were also swabbed to detect carriage of ESBL-producing Enterobacteriaceae. Based on the analysis of these longitudinal data, this study shows that ESBL-producing Klebsiella pneumoniae (ESBL-KP) mostly spreads during close-proximity interactions between individuals, while this is not the case for ESBL-producing Escherichia coli (ESBL-EC), suggesting that ESBL-KP but not ESBL-EC may be controlled by contact reduction interventions.

引用

页数：21

共 44 条

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