Does antibiotic resistance evolve in hospitals?

DOI10.1007/S11538-016-0232-7zbMATH Open1373.92067arXiv1605.03660OpenAlexW2963419506WikidataQ39125398 ScholiaQ39125398MaRDI QIDQ2362166FDOQ2362166

Authors: Portia Mira, Bernd Sturmfels, Miriam Barlow, Anna Leah Seigal 

Publication date: 6 July 2017

Published in: Bulletin of Mathematical Biology (Search for Journal in Brave)

Abstract: Nosocomial outbreaks of bacteria are well-documented. Based on these incidents, and the heavy usage of antibiotics in hospitals, it has been assumed that antibiotic resistance evolves in hospital environments. To test this assumption, we studied resistance phenotypes of bacteria collected from patient isolates at a community hospital over a 2.5-year period. A graphical model analysis shows no association between resistance and patient information other than time of arrival. This allows us to focus on time course data. We introduce a Hospital Transmission Model, based on negative binomial delay. Our main contribution is a statistical hypothesis test called the Nosocomial Evolution of Resistance Detector (NERD). It calculates the significance of resistance trends occurring in a hospital. It can inform hospital staff about the effects of various practices and interventions, can help detect clonal outbreaks, and is available as an R-package. We applied the NERD method to each of the 16 antibiotics in the study via 16 hypothesis tests. For 13 of the antibiotics, we found that the hospital environment had no significant effect upon the evolution of resistance; the hospital is merely a piece of the larger picture. The p-values obtained for the other three antibiotics (Cefepime, Ceftazidime and Gentamicin) indicate that particular care should be taken in hospital practices with these antibiotics. One of the three, Ceftazidime, was significant after accounting for multiple hypotheses, indicating a trend of decreased resistance for this drug.

Full work available at URL: https://arxiv.org/abs/1605.03660

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zbMATH Keywords

negative binomial distributionantibiotic resistanceinfection controlnosocomial outbreaks

Mathematics Subject Classification ID

Medical applications (general) (92C50) Epidemiology (92D30)

Cites Work

• Statistical Analysis of Financial Data in S-Plus
• Graphical models with R.
• Title not available (Why is that?)
• Rational design of antibiotic treatment plans: a treatment strategy for managing evolution and reversing resistance

Cited In (2)

• NERD
• A Markov chain model to investigate the spread of antibiotic‐resistant bacteria in hospitals

Uses Software

• R
• MASS (R)
• gRim

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