Pharmacoepidemiolgy of Infectious Diseases - Université de Versailles Saint Quentin/Inserm U 657  


  HEADProf. Didier Guillemot / didier.guillemot@pasteur.fr
  MEMBERSMrs Inga Bertucci, Ms Julie David, Mr Matthieu Domenech De Celles, Ms Claire Dupont, Mrs Anne Frances-Demond, Ms Jennifer Lasley, Ms Odile Le Minor, Mrs Lulla Opatowski, Dr Christian Perronne, Mrs Laure Petit, Ms Margarita Pons-Salor, Dr Jerome Salomon, Ms Anne Thiebaut, Ms Marie-Anne Vibet, Mrs Laurence Watier


  Annual Report

Our research focuses on the influence of population antiinfectives exposure on the infectious risk and in particular on bacterial resistance to antibiotics. We aim at investigating the interaction between antimicrobial drugs and antimicrobial drug evasion by microbes at the population level, both in hospital and community settings. We explore the interaction between population exposure with antiinfectives and the risk of infectious diseases while taking into account the environmental context of infectious risk dynamic. Tools and approaches we develop for these explorations combine epidemiological investigations, population wide databases, improvement of statistical methods, mathematical modeling (population dynamics) and computarized simulation.

The specific challenges of our research programs are:

  • To improve our understanding of and to quantify the influence of selection due to exposure to multiple antibiotics on the spread and competitiveness of multiresistant bacteria.

  • To investigate factors related to the dynamics of multiresistant bacteria : epidemicity of clones, antibiotic exposure and contacts between individuals.

  • To analyze the public health impact of changes in exposure to antimicrobial drugs.



Main 2009 events :

  1. Determinants of the spread and competitiveness of multiresistant bacteria

We have initiated innovative approach (see below in the research project) for anticipating trends of antibiotic resistance and investigating “intrinsic epidemicity” of multi-resistant bacteria. This approach is based on individual based modeling. At present we have yet an avalaible software beta-version we used to assess the influence of health care peripatetism on MRB superspreading within hospital ward (Temime et al., PNAS 2009).

  1. Impact of the French public health program « Keep antibiotic working !»

Since 2002, we have been analyzing the progression of antibiotic use in France, and evaluating the impact of the national plan. We have carried out a collaboration with the two main French health insurers: the French National Bureau of Health Insurance for Salaried Workers (Caisse National d’Assurance Maladie des Travailleurs Salariés, CNAM-TS) and the French National Bureau of Health Insurance for Self–Employed Individuals (Régime Social des Indépendants, RSI), to obtain individual data of antibiotic reimbursement. This evaluation was based on 2000-2007 data, including 453,407,458 individual reimbursement data records and incidence of Flu-Like Syndromes (FLS) provided by the French Sentinel Network. In comparison to the preintervention period (2000-2002), the total number of antibiotic prescriptions per 100 inhabitants, adjusted for FLS indicence during the winter season, declined by –26.5% (95% confidence interval (CI), –33.5% to –19.6%) over five years. The decline occurred in all 22 regions of France and affected all antibiotic therapeutic classes except quinolones. The greatest decrease of –35.8% (95% CI, –48.3% to –23.2%) was observed among young children 6–15 years. A significant decrease of –45% in the relationship between the incidence of flu-like syndromes and antibiotic prescriptions was observed. This work has recently benn published in Plos Medicine (Sabuncu et al, 2009) and was followed by an editorial written by Stephan Harbarth as well as an opinion paper in the Lancet Infectious Diseases written by Norra MacReady.

Keywords: Anti-infective evasion, pharmaco-epidemiology, public health research



  Publications

Temime L, Opatowski L, Pannet Y, Brun-Buisson C, Boëlle PY, Guillemot D. Peripatetic health-care workers as potential superspreaders. Proc Natl Acad Sci U S A. 2009, 106(43):18420-5.

Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle PY, Watier L, and Guillemot D.Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002-2007. PLoS Med. 2009 Jun 2;6(6):e1000084

Opatowski L, Temime L, Varon E, Leclerc R, Drugeon H, Boëlle PY, Guillemot D. Antibiotic innovation may contribute to slowing the dissemination of multiresistant Streptococcus pneumoniae: the example of ketolides. PLoS ONE. 2008 May 7;3(5): e2089.

Temime L, Boelle PY, Opatowski L, Guillemot D. Impact of capsular switch on invasive pneumococcal disease incidence in a vaccinated population. PLoS ONE. 2008 Sep 19;3(9): e3244.

Hocine M, Guillemot D, Tubert-Bitter P, Moreau T. Testing independence between two Poisson-generated multinomial variables in case-series and cohort studies. Stat Med. 2005; 24(24): 4035-44.





Activity Reports 2009 - Institut Pasteur
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