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Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country.
Elife 2019; 8E

Abstract

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 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.

Authors+Show Affiliations

Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31793878

Citation

Crellen, Thomas, et al. "Transmission Dynamics and Control of Multidrug-resistant Klebsiella Pneumoniae in Neonates in a Developing Country." ELife, vol. 8, 2019.
Crellen T, Turner P, Pol S, et al. Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country. Elife. 2019;8.
Crellen, T., Turner, P., Pol, S., Baker, S., Nguyen Thi Nguyen, T., Stoesser, N., ... Cooper, B. S. (2019). Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country. ELife, 8, doi:10.7554/eLife.50468.
Crellen T, et al. Transmission Dynamics and Control of Multidrug-resistant Klebsiella Pneumoniae in Neonates in a Developing Country. Elife. 2019 Dec 3;8 PubMed PMID: 31793878.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country. AU - Crellen,Thomas, AU - Turner,Paul, AU - Pol,Sreymom, AU - Baker,Stephen, AU - Nguyen Thi Nguyen,To, AU - Stoesser,Nicole, AU - Day,Nicholas Pj, AU - Turner,Claudia, AU - Cooper,Ben S, Y1 - 2019/12/03/ PY - 2019/07/25/received PY - 2019/11/26/accepted PY - 2019/12/4/entrez PY - 2019/12/4/pubmed PY - 2019/12/4/medline KW - epidemiology KW - global health KW - infectious disease KW - microbiology JF - eLife JO - Elife VL - 8 N2 - 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 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. SN - 2050-084X UR - https://www.unboundmedicine.com/medline/citation/31793878/Transmission_dynamics_and_control_of_multidrug-resistant_Klebsiella_pneumoniae_in_neonates_in_a_developing_country L2 - https://doi.org/10.7554/eLife.50468 DB - PRIME DP - Unbound Medicine ER -