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

产超广谱β-内酰胺酶肠杆菌科（ESBL-PE）的持续传播是抗生素耐药性中最重要的问题之一。这也是研究肠杆菌科细菌耐药流行病学复杂性的一个很好的模型。关于社区环境中ESBL-PE传播决定因素的现有数据很少，方法有限，大多基于单中心研究。一个全面的调查，使用现代类型和建模技术是必要的，以发展一个健全的定量了解所涉及的相互作用。已经建立了一个由来自ESBL-EP高流行和低流行国家的具有不同专业知识的研究者组成的联盟。将研究家庭和长期护理机构内ESBL-PE的传播和持续性。将对传播和持久性的个人和群体决定因素以及环境、食品和废水污染等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。该项目中生成的数据将直接为一套数学模型提供信息，这些模型除了封装当前对过程的理解外，还将用于探索不同干预措施控制ESBL-PE传播的潜在有效性。预期输出是考虑细菌克隆和移动的遗传元件以及不同环境中的个体和生态水平因素的ESBL-PE传播的综合表征，以告知公共卫生当局应优先采取的干预措施，以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.