The Impact of Public Health Interventions on the Future Prevalence of ESBL-producingKlebsiella Pneumoniae: a Population Based Mathematical Modelling Study

Salazar-Vizcaya Luisa,Atkinson Andrew,Kronenberg Andreas,Plüss-Suard Catherine,Kouyos Roger D.,Kachalov Viacheslav,Troillet Nicolas,Marschall Jonas,Sommerstein Rami

BMC Infectious Diseases（2022）SCI 3区

University of Bern | University of Zurich | Valais Hospitals

Cited 4|Views16

Abstract

Abstract Background Future prevalence of colonization with extended-spectrum betalactamase (ESBL-) producing K. pneumoniae in humans and the potential of public health interventions against the spread of these resistant bacteria remain uncertain. Methods Based on antimicrobial consumption and susceptibility data recorded during > 13 years in a Swiss region, we developed a mathematical model to assess the comparative effect of different interventions on the prevalence of colonization. Results Simulated prevalence stabilized in the near future when rates of antimicrobial consumption and in-hospital transmission were assumed to remain stable (2025 prevalence: 6.8% (95CI%:5.4–8.8%) in hospitals, 3.5% (2.5–5.0%) in the community versus 6.1% (5.0–7.5%) and 3.2% (2.3–4.2%) in 2019, respectively). When overall antimicrobial consumption was set to decrease by 50%, 2025 prevalence declined by 75% in hospitals and by 64% in the community. A 50% decline in in-hospital transmission rate led to a reduction in 2025 prevalence of 31% in hospitals and no reduction in the community. The best model fit estimated that 49% (6–100%) of observed colonizations could be attributable to sources other than human-to-human transmission within the geographical setting. Conclusions Projections suggests that overall antimicrobial consumption will be, by far, the most powerful driver of prevalence and that a large fraction of colonizations could be attributed to non-local transmissions.

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Key words

ESBL-producing Klebsiella pneumoniae,Resistance,Mathematical model,Public health intervention

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