Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models
Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models
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DOI：
10.1098/rstb.1999.0425
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发表时间：
1999-04-29
影响因子：
6.3
通讯作者：
Anderson, RM
中科院分区：
文献类型：
--
作者：
Austin, DJ;Anderson, RM
人类多种重要病原体中出现的抗生素耐药性对公共卫生构成了全球性威胁。本文描述了最近在使用耐药细菌出现和传播的数学模型方面的工作，范围从患者体内、医院和人群社区。模型开发开始于接受治疗的患者，药代动力学和药效学原理在一个框架内融合，反映了细菌种群生长、药物治疗和针对病原体的免疫反应之间的相互作用。该模型有助于确定需要更精确信息的领域，特别是在药物如何影响病原体的出生和死亡率（药效学）方面。下一个要处理的领域是医院环境中多重耐药细菌的传播。病原体传播动力学模型为评估不同形式干预的相对优点提供了框架，并为控制或根除提供了标准。该模型适用于万古霉素耐药肠球菌在重症监护环境的传播。该模型框架被推广到考虑耐药菌在医院之间的传播。该模型框架考虑到医院规模的异质性，并强调了大型医院在特定国家内维持耐药生物的重要性。耐甲氧西林金黄色葡萄球菌（MRSA）在英格兰和威尔士的传播为模型构建和分析提供了模板。最后一节讨论耐药生物在人群中的出现和传播，以及以药物使用量或使用率衡量的对选择强度的依赖。模型输出拟合芬兰和冰岛的数据，并得出关于一旦药物压力放松，决定传播和衰减速度的关键因素的结论。
The emergence of antibiotic resistance in a wide variety of important pathogens of humans presents a worldwide threat to public health. This paper describes recent work on the use of mathematical models of the emergence and spread of resistance bacteria, on scales ranging from within the patient, in hospitals and within communities of people. Model development starts within the treated patient, and pharmacokinetic and pharmacodynamic principles are melded within a framework that mirrors the interaction between bacterial population growth, drug treatment and the immunological responses targeted at the pathogen. The model helps identify areas in which more precise information is needed, particularly in the context of how drugs influence pathogen birth and death rates (pharmacodynamics). The next area addressed is the spread of multiply drug-resistant bacteria in hospital settings. Models of the transmission dynamics of the pathogen provide a framework for assessing the relative merits of different forms of intervention, and provide criteria for control or eradication. The model is applied to the spread of vancomycin-resistant enterococci in an intensive care setting. This model framework is generalized to consider the spread of resistant organisms between hospitals. The model framework allows for heterogeneity in hospital size and highlights the importance of large hospitals in the maintenance of resistant organisms within a defined country. The spread of methicillin resistant Staphylococcus aureus (MRSA) in England and Wales provides a template for model construction and analysis. The final section addresses the emergence and spread of resistant organisms in communities of people and the dependence on the intensity of selection as measured by the volume or rate of drug use. Model output is fitted to data for Finland and Iceland and conclusions drawn concerning the key factors determining the rate of spread and decay once drug pressure is relaxed.