The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions

Lipsitch, Marc; Bergstrom, Carl T.; Levin, Bruce R.

doi:10.1073/pnas.97.4.1938

Cited by 367 publications

(323 citation statements)

References 64 publications

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“…We show that the prevalence of ARB in hospitals approaches equilibrium rapidly because of the rapid turnover of patients; the average length of stay (LOS) is Ϸ5 days (10,11). Moreover, prevalence changes rapidly in response to changes in hospital infection control (11)(12)(13)(14)(15)(16)(17), so slow and steady increases in resistance must be due to something else, such as increases in the proportion of carriers admitted from the catchment population of a hospital, defined as the population from which patients are drawn, including long-term care facilities (LTCFs), other hospitals, and the community (5,18).…”

mentioning

confidence: 99%

“…Moreover, prevalence changes rapidly in response to changes in hospital infection control (11)(12)(13)(14)(15)(16)(17), so slow and steady increases in resistance must be due to something else, such as increases in the proportion of carriers admitted from the catchment population of a hospital, defined as the population from which patients are drawn, including long-term care facilities (LTCFs), other hospitals, and the community (5,18). The health-care institutions that serve a common catchment population vary substantially in their relative size, transmission rates, and average LOS.…”

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confidence: 99%

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Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Smith

Dushoff

Perencevich

et al. 2004

Proc. Natl. Acad. Sci. U.S.A.

175

116

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Infections with antibiotic-resistant bacteria (ARB) in hospitalized patients are becoming increasingly frequent despite extensive infection-control efforts. Infections with ARB are most common in the intensive care units of tertiary-care hospitals, but the underlying cause of the increases may be a steady increase in the number of asymptomatic carriers entering hospitals. Carriers may shed ARB for years but remain undetected, transmitting ARB to others as they move among hospitals, long-term care facilities, and the community. We apply structured population models to explore the dynamics of ARB, addressing the following questions: (i) What is the relationship between the proportion of carriers admitted to a hospital, transmission, and the risk of infection with ARB? (ii) How do frequently hospitalized patients contribute to epidemics of ARB? (iii) How do transmission in the community, long-term care facilities, and hospitals interact to determine the proportion of the population that is carrying ARB? We offer an explanation for why ARB epidemics have fast and slow phases and why resistance may continue to increase despite infection-control efforts. To successfully manage ARB at tertiary-care hospitals, regional coordination of infection control may be necessary, including tracking asymptomatic carriers through health-care systems

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confidence: 99%

mentioning

confidence: 99%

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Smith

Dushoff

Perencevich

et al. 2004

Proc. Natl. Acad. Sci. U.S.A.

175

116

View full text Add to dashboard Cite

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“…Whereas stochastic models define movements of individuals to be chance events occurring at random time-intervals determined by the model parameters, meaning the outcome may be different for different simulation runs. There have been a number of previous models looking specifically at nosocomial infection transmission dynamics [10][11][12][13][14][15][16][17][18][19]. This work builds on those studies, particularly those by Cooper et al [4,18,19] which use stochastic models to explore the spread of nosocomial pathogens.…”

Section: Mathematical Modellingmentioning

confidence: 99%

Screening strategies in surveillance and control of methicillin-resistant Staphylococcus aureus (MRSA)

2006

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SUMMARYWith reports of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) continuing to increase and therapeutic options decrease, infection control methods are of increasing importance. Here we investigate the relationship between surveillance and infection control. Surveillance plays two roles with respect to control : it allows detection of infected/colonized individuals necessary for their removal from the general population, and it allows quantification of control success. We develop a stochastic model of MRSA transmission dynamics exploring the effects of two screening strategies in an epidemic setting : random and on admission. We consider both hospital and community populations and include control and surveillance in a single framework. Random screening was more efficient at hospital surveillance and allowed nosocomial control, which also prevented epidemic behaviour in the community. Therefore, random screening was the more effective control strategy for both the hospital and community populations in this setting. Surveillance strategies have significant impact on both ascertainment of infection prevalence and its control.

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“…Until now that effort has been predicated on reducing the likelihood of de novo resistance mutations by rapidly eliminating pathogens before they can mutate with large doses of antibiotics administered for long periods and by cycling the antibiotics used in hospitals. This selects efficiently for multiple resistance [121]. Current practise creates strong selection, and because most resistance genes are not de novo mutations but pre-existing and horizontally transferred, strong selection efficiently promotes the very resistance that it is trying to prevent.…”

Section: The Range Of Issues (A) Medically Significant Genetic Variationmentioning

confidence: 99%

Evolutionary medicine: its scope, interest and potential

2012

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This review is aimed at readers seeking an introductory overview, teaching courses and interested in visionary ideas. It first describes the range of topics covered by evolutionary medicine, which include human genetic variation, mismatches to modernity, reproductive medicine, degenerative disease, hostpathogen interactions and insights from comparisons with other species. It then discusses priorities for translational research, basic research and health management. Its conclusions are that evolutionary thinking should not displace other approaches to medical science, such as molecular medicine and cell and developmental biology, but that evolutionary insights can combine with and complement established approaches to reduce suffering and save lives. Because we are on the cusp of so much new research and innovative insights, it is hard to estimate how much impact evolutionary thinking will have on medicine, but it is already clear that its potential is enormous.

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The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions

Cited by 367 publications

References 64 publications

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Screening strategies in surveillance and control of methicillin-resistant Staphylococcus aureus (MRSA)

Evolutionary medicine: its scope, interest and potential

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