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Metapopulation ecology links antibiotic resistance, consumption and patient transfers in a network of hospital wards

View ORCID ProfileJulie Teresa Shapiro, View ORCID ProfileGilles Leboucher, Anne-Florence Myard-Dury, Pascale Girardo, Anatole Luzatti, View ORCID ProfileMélissa Mary, Jean-François Sauzon, View ORCID ProfileBénédicte Lafay, View ORCID ProfileOlivier Dauwalder, Frédéric Laurent, Gérard Lina, View ORCID ProfileChristian Chidiac, Sandrine Couray-Targe, View ORCID ProfileFrançois Vandenesch, View ORCID ProfileJean-Pierre Flandrois, View ORCID ProfileJean-Philippe Rasigade
doi: https://doi.org/10.1101/771790
Julie Teresa Shapiro
1CIRI, Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1; CNRS, UMR5308; Lyon, France
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Gilles Leboucher
2Département de Pharmacie, Hospices Civils de Lyon, Lyon, France
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Anne-Florence Myard-Dury
3Pôle de Santé Publique, Département d’Information Médicale, Hospices Civils de Lyon, Lyon, France
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Pascale Girardo
4Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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Anatole Luzatti
4Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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Mélissa Mary
4Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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Jean-François Sauzon
4Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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Bénédicte Lafay
5Laboratoire de Biométrie et Biologie Evolutive, UMR CNRS 5558, University of Lyon, France
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  • ORCID record for Bénédicte Lafay
Olivier Dauwalder
4Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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Frédéric Laurent
1CIRI, Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1; CNRS, UMR5308; Lyon, France
4Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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Gérard Lina
1CIRI, Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1; CNRS, UMR5308; Lyon, France
4Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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Christian Chidiac
6Service des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France
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Sandrine Couray-Targe
3Pôle de Santé Publique, Département d’Information Médicale, Hospices Civils de Lyon, Lyon, France
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François Vandenesch
1CIRI, Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1; CNRS, UMR5308; Lyon, France
4Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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Jean-Pierre Flandrois
5Laboratoire de Biométrie et Biologie Evolutive, UMR CNRS 5558, University of Lyon, France
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Jean-Philippe Rasigade
1CIRI, Centre International de Recherche en Infectiologie, Université de Lyon; Inserm U1111; Ecole Normale Supérieure de Lyon; Université Lyon 1; CNRS, UMR5308; Lyon, France
4Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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  • For correspondence: jean-philippe.rasigade@univ-lyon1.fr
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Abstract

Antimicrobial resistance (AMR) is a global threat. A better understanding of how antibiotic use and between ward patient transfers (or connectivity) impact hospital AMR can help optimize antibiotic stewardship and infection control strategies. Here, we used metapopulation ecology to explain variations in infection incidences of 17 ESKAPE pathogen variants in a network of 357 hospital wards. Multivariate models identified the strongest influence of ward-level antibiotic use on more resistant variants, and of connectivity on nosocomial species and carbapenem-resistant variants. Pairwise associations between infection incidence and the consumption of specific antibiotics were significantly stronger when such associations represented a priori AMR selection, suggesting that AMR evolves within the network. Piperacillin-tazobactam consumption was the strongest predictor of the cumulative incidence of infections resistant to empirical sepsis therapy. Our data establish that both antibiotic use and connectivity measurably influence hospital AMR and provide a ranking of key antibiotics by their impact on AMR.

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Posted September 19, 2019.
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Metapopulation ecology links antibiotic resistance, consumption and patient transfers in a network of hospital wards
Julie Teresa Shapiro, Gilles Leboucher, Anne-Florence Myard-Dury, Pascale Girardo, Anatole Luzatti, Mélissa Mary, Jean-François Sauzon, Bénédicte Lafay, Olivier Dauwalder, Frédéric Laurent, Gérard Lina, Christian Chidiac, Sandrine Couray-Targe, François Vandenesch, Jean-Pierre Flandrois, Jean-Philippe Rasigade
bioRxiv 771790; doi: https://doi.org/10.1101/771790
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Metapopulation ecology links antibiotic resistance, consumption and patient transfers in a network of hospital wards
Julie Teresa Shapiro, Gilles Leboucher, Anne-Florence Myard-Dury, Pascale Girardo, Anatole Luzatti, Mélissa Mary, Jean-François Sauzon, Bénédicte Lafay, Olivier Dauwalder, Frédéric Laurent, Gérard Lina, Christian Chidiac, Sandrine Couray-Targe, François Vandenesch, Jean-Pierre Flandrois, Jean-Philippe Rasigade
bioRxiv 771790; doi: https://doi.org/10.1101/771790

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