Understanding and modelling reservoirs, vehicles and transmission of ESBL-producing Enterobacteriaceae in the community and long term care facilities

产广谱β -内酰胺酶肠杆菌科（ESBL-PE）的持续传播是抗菌素耐药性的最重要问题之一。这也为研究肠杆菌科耐药的流行病学复杂性提供了一个很好的模型。关于ESBL-PE在社区环境中传播决定因素的现有数据很少，方法有限，而且大多基于单中心研究。使用现代类型和建模技术进行全面调查是必要的，以便对所涉及的相互作用进行合理的定量理解。一个由来自ESBL-EP高发和低发国家的具有不同专业知识的研究人员组成的联盟已经成立。将研究ESBL-PE在家庭和长期护理设施中的传播和持久性。将对传播和持久性的个人和群体层面的决定因素以及包括环境、食品和废水污染在内的其他生态变量进行量化。将使用先进的分子分型技术和最先进的分析方法。该项目产生的数据将直接为一套数学模型提供信息，这些模型除了概括当前对该过程的理解外，还将用于探索控制ESBL-PE传播的不同干预措施的潜在有效性。预期产出是考虑到细菌克隆和移动遗传因素以及不同环境下的个体和生态因素，全面描述ESBL-PE传播特征，以便向公共卫生当局通报应优先采取哪些干预措施来控制这些生物体的传播。

The continuing spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) is among the most important problems in antimicrobial resistance. It is also a good model to investigate the epidemiological complexity of resistance in Enterobacteriaceae. Available data on the transmission determinants of ESBL-PE in community settings are scarce, methodologically limited and mostly based on single centre studies. A comprehensive investigation using modern typing and modelling techniques is warranted to develop a sound quantitative understanding of the interactions involved. A consortium of investigators with diverse expertise from countries with high and low endemicity of ESBL-EP has been created. Transmission and persistence of ESBL-PE within households and long-term care facilities will be studied. Individual and group-level determinants for transmission and persistence will be quantified, together with other ecological variables including environmental, food and wastewater contamination. Advanced molecular typing techniques and state-of-the-art analytical methods will be used. Data generated in this project will directly inform a suite of mathematical models which, in addition to encapsulating current understanding of the processes, will be used to explore the potential effectiveness of different interventions to control ESBL-PE spread. The expected outputs are a comprehensive characterisation of ESBL-PE transmission considering bacterial clones and mobile genetic elements, as well as individual and ecologic-level factors in different settings, to inform public health authorities about interventions that should be prioritised to control transmission of these organisms.