on being the right size the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community是正确的大小的影响,人口规模和随机影响进化的耐药性在医院和社区.pdfVIP

On Being the Right Size: The Impact of Population Size and Stochastic Effects on the Evolution of Drug Resistance in Hospitals and the Community Roger D. Kouyos1,2.*, Pia Abel zur Wiesch1., Sebastian Bonhoeffer1 1 Institute of Integrative Biology, ETH Zurich, Zurich, Switzerland, 2 Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, United States of America Abstract The evolution of drug resistant bacteria is a severe public health problem, both in hospitals and in the community. Currently, some countries aim at concentrating highly specialized services in large hospitals in order to improve patient outcomes. Emergent resistant strains often originate in health care facilities, but it is unknown to what extent hospital size affects resistance evolution and the resulting spillover of hospital-associated pathogens to the community. We used two published datasets from the US and Ireland to investigate the effects of hospital size and controlled for several confounders such as antimicrobial usage, sampling frequency, mortality, disinfection and length of stay. The proportion of patients acquiring both sensitive and resistant infections in a hospital strongly correlated with hospital size. Moreover, we observe the same pattern for both the percentage of resistant infections and the increase of hospital-acquired infections over time. One interpretation of this pattern is that chance effects in small hospitals impede the spread of drug-resistance. To investigate to what extent the size distribution of hospitals can directly affect the prevalence of antibiotic resistance, we use a stochastic epidemiological model describing the spread of drug resistance in a hospital setting as well as the interaction between one or several hospitals and the community. We show that the level of drug resistance typica