The impact of public health interventions on the future prevalence of ESBL-producing Klebsiella pneumoniae: a population based mathematical modelling study

• Published in: BMC infectious diseases Vol. 22; no. 1; p. 487
• Main Authors: Salazar-Vizcaya, Luisa, Atkinson, Andrew, Kronenberg, Andreas, Plüss-Suard, Catherine, Kouyos, Roger D, Kachalov, Viacheslav, Troillet, Nicolas, Marschall, Jonas, Sommerstein, Rami
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23-05-2022; BioMed Central; BMC
• Subjects: Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; Colonization; Consumption; Control; Development and progression; Disease transmission; Distribution; Drug resistance; Enterobacter; Enterobacteriaceae; ESBL-producing Klebsiella pneumoniae; Evaluation; Food contamination & poisoning; Hospitals; Infections; Infectious diseases; Klebsiella; Mathematical analysis; Mathematical model; Mathematical models; Methods; Ordinary differential equations; Pathogens; Pharmacy; Population; Population studies; Population-based studies; Public health; Public health intervention; Reduction; Resistance; Switzerland; Resistance; ESBL-producing Klebsiella pneumoniae; Public health intervention; Mathematical model
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-022-07441-z

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.
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.
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.
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.