Transmission Dynamics and Control of Multidrug-resistant in Neonates in a Developing Country

Overview

Journal Elife

Specialty Biology

Date 2019 Dec 4

PMID 31793878

Citations 10

Authors

Thomas Crellen

Paul Turner

Sreymom Pol

Stephen Baker

To Nguyen Thi Nguyen

Nicole Stoesser

Nicholas Pj Day

Claudia Turner

Ben S Cooper

Affiliations

Soon will be listed here.

Abstract

Multidrug-resistant 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 . 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.

Citing Articles

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