On Being the Right Size: The Impact of Population Size and Stochastic Effects on the Evolution of Drug Resistance in Hospitals and the Community

• DOI: 10.1371/journal.ppat.1001334
• Publication Date: 2011-04-14T20:43:21Z
• Authors: Roger D. Kouyos; Pia Abel zur Wiesch; Sebastian Bonhoeffer
• Keywords: Ancylostoma; QH301-705.5; Drug Evaluation, Preclinical; Drug Resistance; Motor Activity; Ancylostomiasis; 03 medical and health sciences; 0302 clinical medicine; Species Specificity; Depsipeptides; Animals; Large-Conductance Calcium-Activated Potassium Channels; Biology (General); Caenorhabditis elegans; Caenorhabditis elegans Proteins; Anthelmintics; RC581-607; Mycotoxins; 3. Good health; Gene Expression Regulation; Mutation; Haemonchus; Immunologic diseases. Allergy; Haemonchiasis; Drug Antagonism; Research Article

The evolution of drug resistant bacteria is a severe public health problem, both in hospitals and the community. Currently, some countries aim at concentrating highly specialized services large order to improve patient outcomes. Emergent strains often originate care facilities, but it unknown what extent hospital size affects resistance resulting spillover hospital-associated pathogens We used two published datasets from US Ireland investigate effects controlled for several confounders such as antimicrobial usage, sampling frequency, mortality, disinfection length stay. proportion patients acquiring sensitive infections strongly correlated with size. Moreover, we observe same pattern percentage increase hospital-acquired over time. One interpretation this that chance small impede spread drug-resistance. To distribution can directly affect prevalence antibiotic resistance, use stochastic epidemiological model describing setting well interaction between one or show level typically increases population size: In cause fluctuations pathogen even extinctions, which acquisition resistance. Finally, indirect transmission via environmental reservoirs reduce effect because slow turnover environment prevent extinction strains. This implies reducing especially important hospitals, reduction not only reduces overall might also facilitate Overall, our study shows sizes crucial factor