Evidence map›Paper›PMID 30134939›Full record

ArticleBMC medicine2018

Quantifying where human acquisition of antibiotic resistance occurs: a mathematical modelling study.

Gwenan M Knight, Céire Costelloe, Sarah R Deeny, Luke S P Moore, Susan Hopkins, Alan P Johnson, Julie V Robotham, Alison H Holmes

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PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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  14. Ethics and antibiotic resistance.British medical bulletin · 2022
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  19. Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2021
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Gwenan M KnightNational Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK. gwen.knight@lshtm.ac.uk.ORCID 0000-0002-7263-9896
Céire CostelloeNational Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.
Sarah R DeenyData Analytics, The Health Foundation, London, UK.
Luke S P MooreNational Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.
Susan HopkinsNational Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.
Alan P JohnsonNational Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.
Julie V RobothamNational Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.
Alison H HolmesNational Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.

Funding

Department of Health CDF-2016-09-015Medical Research Council MR/P014658/1
6 · The paper itself

Abstract

backgroundAntibiotic-resistant bacteria (ARB) are selected by the use of antibiotics. The rational design of interventions to reduce levels of antibiotic resistance requires a greater understanding of how and where ARB are acquired. Our aim was to determine whether acquisition of ARB occurs more often in the community or hospital setting.

methodsWe used a mathematical model of the natural history of ARB to estimate how many ARB were acquired in each of these two environments, as well as to determine key parameters for further investigation. To do this, we explored a range of realistic parameter combinations and considered a case study of parameters for an important subset of resistant strains in England.

resultsIf we consider all people with ARB in the total population (community and hospital), the majority, under most clinically derived parameter combinations, acquired their resistance in the community, despite higher levels of antibiotic use and transmission of ARB in the hospital. However, if we focus on just the hospital population, under most parameter combinations a greater proportion of this population acquired ARB in the hospital.

conclusionsIt is likely that the majority of ARB are being acquired in the community, suggesting that efforts to reduce overall ARB carriage should focus on reducing antibiotic usage and transmission in the community setting. However, our framework highlights the need for better pathogen-specific data on antibiotic exposure, ARB clearance and transmission parameters, as well as the link between carriage of ARB and health impact. This is important to determine whether interventions should target total ARB carriage or hospital-acquired ARB carriage, as the latter often dominated in hospital populations.

Indexed as

Community-Acquired InfectionsCross InfectionModels, TheoreticalAnti-Bacterial Agentsbeta-Lactam ResistanceDrug Resistance, MicrobialEnglandEscherichia coliEscherichia coli InfectionsHumansAnti-Bacterial AgentsAntibiotic resistanceCommunityHospitalIntervention designMathematical modellingResistance acquisition

Identifiers

PMID30134939
PMCPMC6106940

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.