Los Alamos National Laboratory, Theoretical Biology and Biophysics, Los Alamos, 87544, USA.
University of Portland, Mathematics Department, Portland, 97203, USA.
Sci Rep. 2019 Aug 2;9(1):11245. doi: 10.1038/s41598-019-47359-2.
Invasive non-typhoidal Salmonella (NTS) is among the leading causes of blood stream infections in sub-Saharan Africa and other developing regions, especially among pediatric populations. Invasive NTS can be difficult to treat and have high case-fatality rates, in part due to emergence of strains resistant to broad-spectrum antibiotics. Furthermore, improper treatment contributes to increased antibiotic resistance and death. Point of care (POC) diagnostic tests that rapidly identify invasive NTS infection, and differentiate between resistant and non-resistant strains, may greatly improve patient outcomes and decrease resistance at the community level. Here we present for the first time a model for NTS dynamics in high risk populations that can analyze the potential advantages and disadvantages of four strategies involving POC diagnostic deployment, and the resulting impact on antimicrobial treatment for patients. Our analysis strongly supports the use of POC diagnostics coupled with targeted antibiotic use for patients upon arrival in the clinic for optimal patient and public health outcomes. We show that even the use of imperfect POC diagnostics can significantly reduce total costs and number of deaths, provided that the diagnostic gives results quickly enough that patients are likely to return or stay to receive targeted treatment.
在撒哈拉以南非洲和其他发展中地区，侵袭性非伤寒沙门氏菌（NTS）是血流感染的主要原因之一，尤其是在儿科人群中。侵袭性 NTS 难以治疗，病死率高，部分原因是出现了对广谱抗生素耐药的菌株。此外，不适当的治疗会导致抗生素耐药性增加和死亡。即时检测（POC）诊断测试可以快速识别侵袭性 NTS 感染，并区分耐药菌株和非耐药菌株，这可能极大地改善患者的预后，并降低社区层面的耐药性。在这里，我们首次提出了一种高危人群中 NTS 动力学模型，可以分析涉及 POC 诊断部署的四种策略的潜在优缺点，以及对患者抗菌治疗的影响。我们的分析强烈支持使用 POC 诊断检测，并在患者到达诊所时针对特定患者使用抗生素，以实现最佳的患者和公共卫生结果。我们表明，即使使用不完美的 POC 诊断检测，也可以显著降低总成本和死亡人数，前提是诊断结果足够快，患者有可能返回或留下来接受靶向治疗。
