Acquisition and carriage dynamics of fluoroquinolone resistant Enterobacteriaceae at individual and household levels
Acquisition and carriage dynamics of fluoroquinolone resistant Enterobacteriaceae at individual and household levels
复制标题
个人和家庭层面耐氟喹诺酮类肠杆菌科细菌的获取和携带动态
DOI：
10.1101/2020.10.29.20222364
复制
发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Musicha P
中科院分区：
文献类型：
--
作者：
Musicha P
人们对耐药细菌的携带动态，特别是家庭内的携带动态知之甚少。这限制了制定有效干预措施以控制社区中抗菌素耐药性传播的能力。两组，包括：（i）需要抗菌治疗的尿路感染患者;（ii）未接受抗菌治疗的患者在三个欧洲研究中心前瞻性招募：安特卫普（比利时）、日内瓦（瑞士）和罗兹（波兰）。每名索引患者和最多3名额外的家庭成员在基线、抗菌治疗完成时（或未暴露者第一次采样后7-10天）和第二次采样后28天提供粪便样本。我们使用贝叶斯多状态马尔可夫模型分析了家庭水平和个人水平的氟喹诺酮耐药肠杆菌科（ENUR-E）的采集和携带数据。在个体水平上，我们估计平均基线EARR-E获得率为0.006（95%CrI= [0.004，0.01]）/天，平均携带时间为24.4天（95%CrI =[15.23，41.38]）。在个体水平上，呋喃妥因暴露与ECR-E获得率降低相关（HR=0.28，95%CrI=[0.14，0.56]），而氟喹诺酮暴露与ECR-E获得率无明显相关（HR=1.43，95%CrI =[0.81，2.53]）。有证据表明，不同临床试验机构的EARR-E采集率不同，来自罗兹的EARR-E采集率较高（HR=3.56，95% CrI=[1.92，6.34]）。携带持续时间延长与研究期间暴露于氟喹诺酮或呋喃妥因、前12个月内使用任何抗菌剂以及前往流行地区有关。在家庭层面，我们发现了强有力的证据表明，氟喹诺酮类药物暴露与EARR-E的获得呈正相关（HR=3.43，95%CrI =[1.51，7.74]）。有微弱的证据表明，EARR-E获得与呋喃妥因暴露之间存在负相关（HR=0.42，95%CrI=[0.12，1.24]）。与个人水平相似，携带时间也与家庭水平的抗菌素暴露相关。我们的研究已确定家庭接触者是FQR-E传播的重要途径，并强调需要优先考虑以家庭为重点的干预措施来控制FQR-E传播。
Carriage dynamics of drug-resistant bacteria, especially within households, are poorly understood. This limits the ability to develop effective interventions for controlling the spread of antimicrobial resistance in the community. Two groups consisting of: (i) patients with urinary tract infection requiring antimicrobial treatment; and (ii) patients who were not prescribed antimicrobial treatment were prospectively recruited at three European sites: Antwerp (Belgium), Geneva (Switzerland) and Lodz (Poland). Each index patient and up to three additional household members provided faecal samples at baseline, completion of antimicrobial therapy (or 7-10 days after the first sample for the non-exposed) and 28 days after the second sample. We analysed household-level and individual-level fluoroquinolone resistant Enterobacteriaceae (FQR-E) acquisition and carriage data using Bayesian multi-state Markov models. At the individual level, we estimated a median baseline FQR-E acquisition rate of 0.006 (95%CrI= [0.004, 0.01]) per day, and a median duration of carriage of 24.4 days (95% CrI=[15.23,41.38]). Nitrofurantoin exposure was associated with a reduced rate of FQR-E acquisition (HR=0.28, 95%CrI=[0.14,0.56]), while fluoroquinolone exposure had no clear association with rates of FQR-E acquisition (HR=1.43, 95% CrI=[0.81,2.53]) at individual level. There was evidence that rates of FQR-E acquisition varied by site, and coming from Lodz was associated with a higher acquisition rate (HR=3.56, 95% CrI=[1.92, 6.34]). Prolonged duration of carriage was associated with exposure to fluoroquinolone or nitrofurantoin during the study, use of any antimicrobial agent in the prior 12 months and travel to endemic regions. At household level, we found strong evidence of positive association between FQR-E acquisition and fluoroquinolone exposure (HR=3.43, 95% CrI=[1.51,7.74]). There was weak evidence of negative association between FQR-E acquisition and nitrofurantoin exposure (HR=0.42, 95%CrI=[0.12, 1.24]. Similar to the individual level, carriage duration was also associated with antimicrobial exposure at the household level. Our study has identified within household contacts as an important route for FQR-E transmission and highlights the need for prioritising household focused interventions to control FQR-E spread.
登录
查看更多内容
DOI：
--
发表时间：
2007
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
P. Reddy;M. Malczynski;A. Obias;S. Reiner;N. Jin;J. Huang;G. Noskin;T. Zembower
通讯作者：
P. Reddy;M. Malczynski;A. Obias;S. Reiner;N. Jin;J. Huang;G. Noskin;T. Zembower
克隆性在氟喹诺酮耐药细菌全球传播中的作用。
影响因子：
11.8
作者：
K. Klugman
通讯作者：
K. Klugman
医院队列中产碳青霉烯酶肠杆菌科细菌的携带持续时间——对感染控制措施的影响
DOI：
10.1101/19001479
发表时间：
2019
期刊：
--
影响因子：
--
作者：
Mo Y
通讯作者：
Mo Y
影响因子：
13.6
作者：
Becattini S;Taur Y;Pamer EG
通讯作者：
Pamer EG
影响因子：
3.7
作者：
Pouwels, Koen B.;Muller-Pebody, Berit;Robotham, Julie V.
通讯作者：
Robotham, Julie V.