Cook County Health and Hospitals System, Chicago.
Hektoen Institute of Medicine, Chicago.
Clin Infect Dis. 2018 Jul 18;67(3):407-410. doi: 10.1093/cid/ciy084.
In 2013, New Delhi metallo-β-lactamase (NDM)-producing Escherichia coli, a type of carbapenem-resistant Enterobacteriaceae uncommon in the United States, was identified in a tertiary care hospital (hospital A) in northeastern Illinois. The outbreak was traced to a contaminated duodenoscope. Patient-sharing patterns can be described through social network analysis and ego networks, which could be used to identify hospitals most likely to accept patients from a hospital with an outbreak.
Using Illinois' hospital discharge data and the Illinois extensively drug-resistant organism (XDRO) registry, we constructed an ego network around hospital A. We identified which facilities NDM outbreak patients subsequently visited and whether the facilities reported NDM cases.
Of the 31 outbreak cases entered into the XDRO registry who visited hospital A, 19 (61%) were subsequently admitted to 13 other hospitals during the following 12 months. Of the 13 hospitals, the majority (n = 9; 69%) were in our defined ego network, and 5 of those 9 hospitals consequently reported at least 1 additional NDM case. Ego network facilities were more likely to identify cases compared to a geographically defined group of facilities (9/22 vs 10/66; P = .01); only 1 reported case fell outside of the ego network.
The outbreak hospital's ego network accurately predicted which hospitals the outbreak patients would visit. Many of these hospitals reported additional NDM cases. Prior knowledge of this ego network could have efficiently focused public health resources on these high-risk facilities.
2013 年，在伊利诺伊州东北部的一家三级保健医院（医院 A）发现了产新德里金属β-内酰胺酶（NDM）的大肠埃希菌，这是一种在美国不常见的耐碳青霉烯类肠杆菌科细菌。该暴发可追溯到污染的十二指肠镜。通过社会网络分析和个体网络，可以描述患者共享模式，这可以用来确定最有可能接受暴发医院患者的医院。
利用伊利诺伊州的医院出院数据和伊利诺伊州广泛耐药菌（XDRO）登记处，我们围绕医院 A 构建了一个个体网络。我们确定了 NDM 暴发患者随后访问的设施以及这些设施是否报告了 NDM 病例。
在 XDRO 登记处输入的 31 例暴发病例中，有 19 例（61%）在随后的 12 个月内被收治到 13 家其他医院。在这 13 家医院中，大多数（n=9；69%）在我们定义的个体网络中，其中 9 家医院中有 5 家随后报告了至少 1 例其他 NDM 病例。与地理定义的一组设施相比，个体网络设施更有可能发现病例（9/22 与 10/66；P=0.01）；只有 1 例报告病例不在个体网络之外。
暴发医院的个体网络准确预测了暴发患者将访问的医院。这些医院中有许多报告了额外的 NDM 病例。事先了解这个个体网络可以有效地将公共卫生资源集中在这些高风险设施上。
