Close proximity interactions support transmission of ESBL-K. Pneumoniae but not ESBL-E. coli in healthcare settings

BOËLLEID, PIERRE-YVES; GUILLEMOT, DIDIER; ALVAREZ, ANNE SOPHIE; BERTUCCI, INGA; DANNET, FLORENCE; DE CELLÈS, MATTHIEU DOMENECH; GAILLARD, JEAN-LOUIS; LAWRENCE, CHRISTINE; LIGIER, CAROLINE; SACLEUX, CATHERINE; PERARD, MARIE; THIEBAUT, ANNE; VILLAIN, ISABELLE; DUVAL, AUDREY; FLEURY, ERIC; TEMIMEID, LAURA; BARAFFE, AUDREY; BOËLLE, PIERRE-YVES; DELABY, MARIE LAURE; FLEURY, ERIC; LABRADOR, BORIS; OBADIA, THOMAS; LEGRAND, JUDITH; HERRMANN, JEAN-LOUIS; MARTINET, LUCIE; OPATOWSKIID, LULLA; SALOMON, JÉRÔME; BEIRO, MARIANO; PETIT, LAURE; CYNCYNATUS, CAMILLE; THOMAS, DAMIEN; DENYS, PIERRE; FRABOULET, ANTOINE; LASLEY, JENNIFER; MINOR, ODILE LE; MIGNON, KARINE; OBADIA, THOMAS; REMY, LAETICIA; TRONCHET, PHILIPPE

PLOS COMPUTATIONAL BIOLOGY

PUBLIC LIBRARY SCIENCE

Año: 2019 vol. 15

1553-734X

Antibiotic-resistance of hospital-acquired infections is a major public health issue. The worldwide emergence and diffusion of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, including Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), is of particular concern. Preventing their nosocomial spread requires understanding their transmission. Using Close Proximity Interactions (CPIs), measured by wearable sensors, and weekly ESBL-EC?and ESBL-KP?carriage data, we traced their possible transmission paths among 329 patients in a 200-bed long-term care facility over 4 months. Based on phenotypically defined resistance profiles to 12 antibiotics only, new bacterial acquisitions were tracked. Extending a previously proposed statistical method, the CPI network?s ability to support observed incident-colonization episodes of ESBL-EC and ESBL-KP was tested. Finally, mathematical modeling based on our findings assessed the effect of several infection-control measures. A potential infector was identified in the CPI network for 80% (16/20) of ESBL-KP acquisition episodes. The lengths of CPI paths between ESBL-KP incident cases and their potential infectors were shorter than predicted by chance (P = 0.02), indicating that CPI-network relationships were consistent with dissemination. Potential ESBL-EC infectors were identified for 54% (19/35) of the acquisitions, with longer-than-expected lengths of CPI paths. These contrasting results yielded differing impacts of infection control scenarios, with contact reduction interventions proving less effective for ESBL-EC than for ESBL-KP. These results highlight the widely variable transmission patterns among ESBL-producing Enterobacteriaceae species. CPI networks supported ESBL-KP, but not ESBL-EC spread. These outcomes could help design more specific surveillance and control strategies to prevent in-hospital Enterobacteriaceae dissemination.