Otete Eroboghene H, Ahankari Anand S, Jones Helen, Bolton Kirsty J, Jordan Caroline W, Boswell Tim C, Wilcox Mark H, Ferguson Neil M, Beck Charles R, Puleston Richard L
School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom.
Melbourne School of Population and Global Health , University of Melbourne, Melbourne, Australia ; School of Mathematical Sciences, University of Nottingham, Nottingham, United Kingdom.
PLoS One. 2013 Dec 20;8(12):e84224. doi: 10.1371/journal.pone.0084224. eCollection 2013.
Mathematical modelling of Clostridium difficile infection dynamics could contribute to the optimisation of strategies for its prevention and control. The objective of this systematic review was to summarise the available literature specifically identifying the quantitative parameters required for a compartmental mathematical model of Clostridium difficile transmission.
Six electronic healthcare databases were searched and all screening, data extraction and study quality assessments were undertaken in duplicate. Results were synthesised using a narrative approach.
Fifty-four studies met the inclusion criteria. Reproduction numbers for hospital based epidemics were described in two studies with a range from 0.55 to 7. Two studies provided consistent data on incubation periods. For 62% of cases, symptoms occurred in less than 4 weeks (3-28 days) after infection. Evidence on contact patterns was identified in four studies but with limited data reported for populating a mathematical model. Two studies, including one without clinically apparent donor-recipient pairs, provided information on serial intervals for household or ward contacts, showing transmission intervals of <1 week in ward based contacts compared to up to 2 months for household contacts. Eight studies reported recovery rates of between 75%-100% for patients who had been treated with either metronidazole or vancomycin. Forty-nine studies gave recurrence rates of between 3% and 49% but were limited by varying definitions of recurrence. No study was found which specifically reported force of infection or net reproduction numbers.
There is currently scant literature overtly citing estimates of the parameters required to inform the quantitative modelling of Clostridium difficile transmission. Further high quality studies to investigate transmission parameters are required, including through review of published epidemiological studies where these quantitative estimates may not have been explicitly estimated, but that nonetheless contain the relevant data to allow their calculation.
艰难梭菌感染动态的数学建模有助于优化其预防和控制策略。本系统评价的目的是总结现有文献，特别确定艰难梭菌传播的房室数学模型所需的定量参数。
检索了六个电子医疗数据库，所有筛选、数据提取和研究质量评估均重复进行。结果采用叙述性方法进行综合。
54项研究符合纳入标准。两项研究描述了医院内疫情的繁殖数，范围为0.55至7。两项研究提供了关于潜伏期的一致数据。62%的病例在感染后不到4周（3 - 28天）出现症状。四项研究确定了接触模式的证据，但用于填充数学模型的数据有限。两项研究，包括一项没有临床明显供体 - 受体对的研究，提供了家庭或病房接触的连续间隔信息，显示病房接触的传播间隔小于1周，而家庭接触可达2个月。八项研究报告了接受甲硝唑或万古霉素治疗的患者的恢复率在75% - 100%之间。49项研究给出的复发率在3%至49%之间，但受复发定义不同的限制。未发现专门报告感染力或净繁殖数的研究。
目前公开引用艰难梭菌传播定量建模所需参数估计值的文献很少。需要进一步开展高质量研究来调查传播参数，包括通过审查已发表的流行病学研究，在这些研究中，这些定量估计可能未被明确估计，但仍包含允许计算这些参数的数据。
