On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.

The evolution of drug resistant bacteria is a severe public health problem, both in hospitals and in the community. Currently, some countries aim at concentrating highly specialized services in large hospitals in order to improve patient outcomes. Emergent resistant strains often originate in health...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Roger D Kouyos, Pia Abel Zur Wiesch, Sebastian Bonhoeffer
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Immunologic diseases. Allergy RC581-607 Biology (General) QH301-705.5
Acceso en línea:	https://doaj.org/article/f88744cf7714497b922346543b2136eb
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:f88744cf7714497b922346543b2136eb
record_format	dspace
spelling	oai:doaj.org-article:f88744cf7714497b922346543b2136eb2021-11-18T06:03:28ZOn being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.1553-73661553-737410.1371/journal.ppat.1001334https://doaj.org/article/f88744cf7714497b922346543b2136eb2011-04-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21533212/pdf/?tool=EBIhttps://doaj.org/toc/1553-7366https://doaj.org/toc/1553-7374The evolution of drug resistant bacteria is a severe public health problem, both in hospitals and in the community. Currently, some countries aim at concentrating highly specialized services in large hospitals in order to improve patient outcomes. Emergent resistant strains often originate in health care facilities, but it is unknown to what extent hospital size affects resistance evolution and the resulting spillover of hospital-associated pathogens to the community. We used two published datasets from the US and Ireland to investigate the effects of hospital size and controlled for several confounders such as antimicrobial usage, sampling frequency, mortality, disinfection and length of stay. The proportion of patients acquiring both sensitive and resistant infections in a hospital strongly correlated with hospital size. Moreover, we observe the same pattern for both the percentage of resistant infections and the increase of hospital-acquired infections over time. One interpretation of this pattern is that chance effects in small hospitals impede the spread of drug-resistance. To investigate to what extent the size distribution of hospitals can directly affect the prevalence of antibiotic resistance, we use a stochastic epidemiological model describing the spread of drug resistance in a hospital setting as well as the interaction between one or several hospitals and the community. We show that the level of drug resistance typically increases with population size: In small hospitals chance effects cause large fluctuations in pathogen population size or even extinctions, both of which impede the acquisition and spread of drug resistance. Finally, we show that indirect transmission via environmental reservoirs can reduce the effect of hospital size because the slow turnover in the environment can prevent extinction of resistant strains. This implies that reducing environmental transmission is especially important in small hospitals, because such a reduction not only reduces overall transmission but might also facilitate the extinction of resistant strains. Overall, our study shows that the distribution of hospital sizes is a crucial factor for the spread of drug resistance.Roger D KouyosPia Abel Zur WieschSebastian BonhoefferPublic Library of Science (PLoS)articleImmunologic diseases. AllergyRC581-607Biology (General)QH301-705.5ENPLoS Pathogens, Vol 7, Iss 4, p e1001334 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Immunologic diseases. Allergy RC581-607 Biology (General) QH301-705.5
spellingShingle	Immunologic diseases. Allergy RC581-607 Biology (General) QH301-705.5 Roger D Kouyos Pia Abel Zur Wiesch Sebastian Bonhoeffer On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.
description	The evolution of drug resistant bacteria is a severe public health problem, both in hospitals and in the community. Currently, some countries aim at concentrating highly specialized services in large hospitals in order to improve patient outcomes. Emergent resistant strains often originate in health care facilities, but it is unknown to what extent hospital size affects resistance evolution and the resulting spillover of hospital-associated pathogens to the community. We used two published datasets from the US and Ireland to investigate the effects of hospital size and controlled for several confounders such as antimicrobial usage, sampling frequency, mortality, disinfection and length of stay. The proportion of patients acquiring both sensitive and resistant infections in a hospital strongly correlated with hospital size. Moreover, we observe the same pattern for both the percentage of resistant infections and the increase of hospital-acquired infections over time. One interpretation of this pattern is that chance effects in small hospitals impede the spread of drug-resistance. To investigate to what extent the size distribution of hospitals can directly affect the prevalence of antibiotic resistance, we use a stochastic epidemiological model describing the spread of drug resistance in a hospital setting as well as the interaction between one or several hospitals and the community. We show that the level of drug resistance typically increases with population size: In small hospitals chance effects cause large fluctuations in pathogen population size or even extinctions, both of which impede the acquisition and spread of drug resistance. Finally, we show that indirect transmission via environmental reservoirs can reduce the effect of hospital size because the slow turnover in the environment can prevent extinction of resistant strains. This implies that reducing environmental transmission is especially important in small hospitals, because such a reduction not only reduces overall transmission but might also facilitate the extinction of resistant strains. Overall, our study shows that the distribution of hospital sizes is a crucial factor for the spread of drug resistance.
format	article
author	Roger D Kouyos Pia Abel Zur Wiesch Sebastian Bonhoeffer
author_facet	Roger D Kouyos Pia Abel Zur Wiesch Sebastian Bonhoeffer
author_sort	Roger D Kouyos
title	On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.
title_short	On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.
title_full	On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.
title_fullStr	On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.
title_full_unstemmed	On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.
title_sort	on being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/f88744cf7714497b922346543b2136eb
work_keys_str_mv	AT rogerdkouyos onbeingtherightsizetheimpactofpopulationsizeandstochasticeffectsontheevolutionofdrugresistanceinhospitalsandthecommunity AT piaabelzurwiesch onbeingtherightsizetheimpactofpopulationsizeandstochasticeffectsontheevolutionofdrugresistanceinhospitalsandthecommunity AT sebastianbonhoeffer onbeingtherightsizetheimpactofpopulationsizeandstochasticeffectsontheevolutionofdrugresistanceinhospitalsandthecommunity
_version_	1718424704326303744

On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.

Ejemplares similares