PT  - JOURNAL ARTICLE
AU  - Julie Teresa Shapiro
AU  - Gilles Leboucher
AU  - Anne-Florence Myard-Dury
AU  - Pascale Girardo
AU  - Anatole Luzatti
AU  - Mélissa Mary
AU  - Jean-François Sauzon
AU  - Bénédicte Lafay
AU  - Olivier Dauwalder
AU  - Frédéric Laurent
AU  - Gérard Lina
AU  - Christian Chidiac
AU  - Sandrine Couray-Targe
AU  - François Vandenesch
AU  - Jean-Pierre Flandrois
AU  - Jean-Philippe Rasigade
TI  - Metapopulation ecology links antibiotic resistance, consumption and patient transfers in a network of hospital wards
AID  - 10.1101/771790
DP  - 2019 Jan 01
TA  - bioRxiv
PG  - 771790
4099  - http://biorxiv.org/content/early/2019/09/19/771790.short
4100  - http://biorxiv.org/content/early/2019/09/19/771790.full
AB  - 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.