Close proximity interactions support transmission of ESBL-K. pneumoniae but not ESBL-E. coli in healthcare settings

PLoS Comput Biol. 2019 May 30;15(5):e1006496. doi: 10.1371/journal.pcbi.1006496. eCollection 2019 May.

Abstract

Antibiotic-resistance of hospital-acquired infections is a major public health issue. The worldwide emergence and diffusion of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, including Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), is of particular concern. Preventing their nosocomial spread requires understanding their transmission. Using Close Proximity Interactions (CPIs), measured by wearable sensors, and weekly ESBL-EC-and ESBL-KP-carriage data, we traced their possible transmission paths among 329 patients in a 200-bed long-term care facility over 4 months. Based on phenotypically defined resistance profiles to 12 antibiotics only, new bacterial acquisitions were tracked. Extending a previously proposed statistical method, the CPI network's ability to support observed incident-colonization episodes of ESBL-EC and ESBL-KP was tested. Finally, mathematical modeling based on our findings assessed the effect of several infection-control measures. A potential infector was identified in the CPI network for 80% (16/20) of ESBL-KP acquisition episodes. The lengths of CPI paths between ESBL-KP incident cases and their potential infectors were shorter than predicted by chance (P = 0.02), indicating that CPI-network relationships were consistent with dissemination. Potential ESBL-EC infectors were identified for 54% (19/35) of the acquisitions, with longer-than-expected lengths of CPI paths. These contrasting results yielded differing impacts of infection control scenarios, with contact reduction interventions proving less effective for ESBL-EC than for ESBL-KP. These results highlight the widely variable transmission patterns among ESBL-producing Enterobacteriaceae species. CPI networks supported ESBL-KP, but not ESBL-EC spread. These outcomes could help design more specific surveillance and control strategies to prevent in-hospital Enterobacteriaceae dissemination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / pharmacology
  • Cross Infection / epidemiology*
  • Disease Transmission, Infectious / prevention & control*
  • Drug Resistance, Bacterial / physiology
  • Drug Resistance, Microbial
  • Enterobacteriaceae / drug effects
  • Escherichia coli / drug effects
  • Escherichia coli Infections / microbiology
  • Female
  • Hospitals
  • Humans
  • Infection Control / methods*
  • Klebsiella pneumoniae / drug effects
  • Male
  • Middle Aged
  • Wireless Technology
  • beta-Lactamases / metabolism

Substances

  • Anti-Bacterial Agents
  • beta-Lactamases

Grants and funding

This study was supported by the European Commission under the Life Science Health Priority of the 6th Framework Program (MOSAR network contract LSHP-CT-2007-037941), funding was also received from the French Government through the National Clinical Research Program and the Investissement d'Avenir program, Laboratoire d'Excellence "Integrative Biology of Emerging Infectious Diseases" (grant no. ANR-10-LABX-62-IBEID, http://www.agence-nationale-recherche.fr/ProjetIA-10-LABX-0062) to DG and from the Ecole des Hautes Etudes en Santé Publique (EHESP, https://www.ehesp.fr/) to AD. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.