Austin D J, Anderson R M
The Wellcome Trust Centre for the Epidemiology of Infectious Disease, University of Oxford, Oxford, OX1 3PS, United Kingdom. daren.
J Infect Dis. 1999 Apr;179(4):883-91. doi: 10.1086/314682.
A simple epidemiological framework for the analysis of the transmission dynamics of hospital outbreaks of epidemic methicillin-resistant Staphylococcus aureus (EMRSA) and vancomycin-resistant enterococci (VRE) in hospitals in England and Wales is presented. Epidemic strains EMRSA-15 and EMRSA-16 are becoming endemic in hospitals in the United Kingdom, and theory predicts that EMRSA-15 and EMRSA-16 will reach respective endemic levels of 158 (95% confidence interval [CI], 143-173) and 116 (95% CI, 109-123) affected hospitals with stochastic fluctuations of up to 30 hospitals in each case. An epidemic of VRE is still at an early stage, and the incidence of hospitals newly affected by VRE is growing exponentially at a rate r=0.51/year (95% CI, 0.48-0.54). The likely impact of introducing surveillance policies if action is taken sufficiently early is estimated. Finally, the role of heterogeneity in hospital size is considered: "Super-spreader hospitals" may increase transmission by 40%-132% above the expected mean.
本文提出了一个简单的流行病学框架，用于分析英格兰和威尔士医院中耐甲氧西林金黄色葡萄球菌（EMRSA）和耐万古霉素肠球菌（VRE）医院感染暴发的传播动态。流行菌株EMRSA - 15和EMRSA - 16在英国医院中正逐渐成为地方流行菌株，理论预测EMRSA - 15和EMRSA - 16将分别达到各自的地方流行水平，即受影响医院数分别为158家（95%置信区间[CI]，143 - 173）和116家（95% CI，109 - 123），每种情况随机波动幅度可达30家医院。VRE的流行仍处于早期阶段，新受VRE影响的医院发病率以每年r = 0.51的速率呈指数增长（95% CI，0.48 - 0.54）。估计了如果尽早采取行动引入监测政策可能产生的影响。最后，考虑了医院规模异质性的作用：“超级传播医院”可能使传播比预期均值增加40% - 132%。
