Publication: Clustering of antimicrobial resistance outbreaks across bacterial species in the intensive care unit.
Accepted Date
2013-03-14
Issued Date
2013-07
Copyright Date
2013
Resource Type
Language
eng
ISSN
1058-4838 (printed)
1537-6591 (electronic)
1537-6591 (electronic)
Rights
Mahidol University
Rights Holder(s)
Clinical infectious diseases
Bibliographic Citation
Vlek AL, Cooper BS, Kypraios T, Cox A, Edgeworth JD, Auguet OT. Clustering of antimicrobial resistance outbreaks across bacterial species in the intensive care unit. Clin Infect Dis. 2013 Jul;57(1):65-76.
Suggested Citation
Vlek, Anne L. M., Cooper, Ben S., Kypraios, Theodore, Cox, Andy, Edgeworth, Jonathan D., Auguet, Olga Tosas Clustering of antimicrobial resistance outbreaks across bacterial species in the intensive care unit.. Vlek AL, Cooper BS, Kypraios T, Cox A, Edgeworth JD, Auguet OT. Clustering of antimicrobial resistance outbreaks across bacterial species in the intensive care unit. Clin Infect Dis. 2013 Jul;57(1):65-76.. doi:10.1093/cid/cit192 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/860
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Title
Clustering of antimicrobial resistance outbreaks across bacterial species in the intensive care unit.
Corresponding Author(s)
Abstract
BACKGROUND: There are frequent reports of intensive care unit (ICU) outbreaks due
to transmission of particular antibiotic-resistant bacteria. Less is known about
the burden of outbreaks of resistance due to horizontal transfer of mobile
genetic elements between species. Moreover, the potential of existing statistical
software as a preliminary means for detecting such events has never been
assessed. This study uses a software package to determine the burden of species
and resistance outbreaks in 2 adjacent ICUs and to look for evidence of
clustering of resistance outbreaks consistent with interspecies transmission of
resistance elements.
METHODS: A retrospective analysis of data from 2 adjacent 15-bed adult ICUs
between 2002 and 2009 was undertaken. Detection of bacterial species-groups and
resistance outbreaks was conducted using SaTScan and WHONet-SaTScan software.
Resampling and permutation methods were applied to investigate temporal
clustering of outbreaks.
RESULTS: Outbreaks occurred for 69% of bacterial species-groups (18/26), and
resistance outbreaks were detected against 63% of antibiotics (10/16). Resistance
outbreaks against 7 of 10 antibiotics were observed in multiple species-groups
simultaneously and there was evidence of inter-species-group dependence for 4 of
7 antibiotics; background temporal changes in resistance did not explain the
temporal aggregation of outbreaks in 3 of 7 antibiotics.
CONCLUSIONS: Species outbreaks occurred for the majority of bacteria commonly
identified in the ICU. There was evidence for frequent temporal clustering of
resistance outbreaks consistent with interspecies transmission of resistance
elements. Wider application of outbreak detection software combined with targeted
sequencing of bacterial genomes is needed to understand the contribution of
interspecies gene transfer to resistance emergence.