Understanding and modelling reservoirs, vehicles and transmission of ESBL-producing Enterobacteriaceae in the community and long term care facilities





Research Project: 2017-04-23 - 2021-06-30
Total sum awarded: €2 100 883

The continuing spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) is among the most important problems in antimicrobial resistance. It is also a good model to investigate the epidemiological complexity of resistance in Enterobacteriaceae. Available data on the transmission determinants of ESBL-PE in community settings are scarce, methodologically limited and mostly based on single centre studies. A comprehensive investigation using present typing and modelling techniques is warranted to develop a sound quantitative understanding of the interactions involved. A consortium of investigators with diverse expertise from countries with high and low endemicity of ESBL-EP has been created. Transmission and persistence of ESBL-PE within households and longterm care facilities will be studied. Individual and group-level determinants for transmission and persistence will be quantified, together with other ecological variables including environmental, food and wastewater contamination. Advanced molecular typing techniques and state of the art analytical methods will be used. Data generated in this project will directly inform a suite of mathematical models which, in addition to encapsulating current understanding of the processes, will be used to explore the potential effectiveness of different interventions to control ESBL-PE spread. The expected outputs are a comprehensive characterisation of ESBL-PE transmission considering bacterial clones and mobile genetic elements, as well as individual and ecologic-level factors in different settings, to inform public health authorities about interventions that shouldbe prioritised to control transmission of these organisms.

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  • Jesús Rodríguez-Baño, Hospital Universitario Virgen Macarena, Spain (Coordinator)
  • Evelina Tacconelli, University Hospital Tübingen, Germany (Partner)
  • Stephan Harbarth, University of Geneva, Switzerland (Partner)
  • Jan Kluytmans, University Medical Centre Utrecht, Netherlands (Partner)
  • Didier Hocquet, University Hospital of Besançon, France (Partner)
  • Ben Cooper, University of Oxford, United Kingdom (Partner)

MODERN is an international collaborative project investigating the reservoirs and transmission of Enterobacteriaceae producing extended-spectrum β-lactamases, a group of antibiotic-resistant bacteria that has spread worldwide recently. The study is centered in transmission in non-hospital environment such as households and nursing homes, and include food products, environmental reservoirs and wastewater. Advanced epidemiological methods and whole genome sequencing are being used to identify the rate and risk factors for transmission of these bacteria among residents in these environments in order to produce the information needed to build mathematical models explaining their spread, which will allow to estimate the impact of potential control measures. Very exhaustive and state-of-the-art studies have been carried out to see the characteristics of these bacteria and their way of transmission, which is different in different species. Knowing this, and adding all the demographic characteristics and risk factors collected from each participant, using advanced mathematical methodology, a model is developed that allows predicting transmission. The ultimate goal is to be able to act at critical points in order to end the problem of antibiotic resistance.