The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions
The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions
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DOI：
10.1073/pnas.97.4.1938
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发表时间：
2000-02-15
影响因子：
11.1
通讯作者：
Levin, BR
中科院分区：
文献类型：
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作者：
Lipsitch, M;Bergstrom, CT;Levin, BR
采用一个简单的医院内细菌传播数学模型，研究控制细菌在医院内传播和降低医院内病原菌耐药性的措施的效果。该模型预测：(I)在医院使用一种尚未出现耐药性的抗生素，在个人层面(优势比)将与携带对其他抗生素具有耐药性的细菌正相关，但在群体层面(流行率)负相关。因此，对个别风险因素的推断可能会产生误导性的结论，即抗生素的使用对另一种抗生素的耐药性的影响。(2)减少所有细菌在医院内传播的非特定干预措施将不成比例地降低耐药细菌的定殖率。(3)成功干预后耐药性流行率的变化将在几周至几个月的时间尺度上发生，比社区获得性感染的速度快得多。此外，在医院里，耐药性可能会迅速下降，即使它不会带来健康成本。将该模型的预测结果与其他模型的预测结果和已发表的数据进行了比较。讨论了阻力控制和研究设计的意义，以及模型的局限性和假设。
A simple mathematical model of bacterial transmission within a hospital was used to study the effects of measures to control nosocomial transmission of bacteria and reduce antimicrobial resistance in nosocomial pathogens. The model predicts that: (i) Use of an antibiotic for which resistance is not yet present in a hospital will be positively associated at the individual level (odds ratio) with carriage of bacteria resistant to other antibiotics, but negatively associated at the population level (prevalence). Thus inferences from individual risk factors can yield misleading conclusions about the effect of antibiotic use on resistance to another antibiotic. (ii) Nonspecific interventions that reduce transmission of all bacteria within a hospital will disproportionately reduce the prevalence of colonization with resistant bacteria. (iii) Changes in the prevalence of resistance after a successful intervention will occur on a time scale of weeks to months, considerably faster than in community-acquired infections. Moreover, resistance can decline rapidly in a hospital even if it does not carry a fitness cost. The predictions of the model are compared with those of other models and published data. The implications for resistance control and study design are discussed, along with the limitations and assumptions of the model.