Institute of Applied Mathematics and Mechanics, University of Warsaw, Banacha 2, 02-097 Warsaw, Poland.
Institute of Applied Mathematics and Mechanics, University of Warsaw, Banacha 2, 02-097 Warsaw, Poland; Institute of High Pressure Physics, Polish Academy of Sciences, Sokolowska 29/37, 01-142 Warsaw, Poland; Research Institute for Applied Mechanics, Kyushu University, Kasuga, Fukuoka 816-8580, Japan.
Epidemics. 2020 Dec;33:100408. doi: 10.1016/j.epidem.2020.100408. Epub 2020 Oct 21.
The spread of resistant bacteria in hospitals is an increasing problem worldwide. Transfers of patients, who may be colonized with resistant bacteria, are considered to be an important driver of promoting resistance. Even though transmission rates within a hospital are often low, readmissions of patients who were colonized during an earlier hospital stay lead to repeated introductions of resistant bacteria into hospitals. We developed a mathematical model that combines a deterministic model for within-hospital spread of pathogens, discharge to the community and readmission, with a hospital-community network simulation of patient transfers between hospitals. Model parameters used to create the hospital-community network are obtained from two health insurance datasets from Germany. For parameter values representing transmission of resistant Enterobacteriaceae, we compute estimates for the single admission reproduction numbers R and the basic reproduction numbers R per hospital-community pair. We simulate the spread of colonization through the network of hospitals, and investigate how increasing connectedness of hospitals through the network influences the prevalence in the hospital-community pairs. We find that the prevalence in hospitals is determined by their R and R values. Increasing transfer rates between network nodes tend to lower the overall prevalence in the network by diluting the high prevalence of hospitals with high R to hospitals where persistent spread is not possible. We conclude that hospitals with high reproduction numbers represent a continuous source of risk for importing resistant pathogens for hospitals with otherwise low levels of transmission. Moreover, high risk hospital-community nodes act as reservoirs of pathogens in a densely connected network.
医院中耐药菌的传播是一个全球性的日益严重的问题。携带耐药菌的患者的转移被认为是促进耐药性的一个重要因素。尽管医院内的传播率通常较低，但先前住院期间定植耐药菌的患者再次入院会导致耐药菌反复引入医院。我们开发了一种数学模型，该模型将病原体在医院内传播的确定性模型、出院到社区和再次入院结合在一起，并对医院-社区之间的患者转移进行了医院-社区网络模拟。用于创建医院-社区网络的模型参数是从德国的两个健康保险数据集获得的。对于代表耐药肠杆菌传播的参数值，我们计算了单个入院繁殖数 R 和每对医院-社区的基本繁殖数 R 的估计值。我们模拟了定植的传播通过医院网络，并研究了通过网络增加医院之间的连通性如何影响医院-社区对的流行率。我们发现，医院的流行率由其 R 和 R 值决定。网络节点之间的转移率增加往往会通过将高 R 值的医院的高流行率稀释到不可能持续传播的医院来降低网络中的总体流行率。我们得出的结论是，繁殖数高的医院对于传播率低的医院来说，是引入耐药病原体的持续风险源。此外，高风险的医院-社区节点在密集连接的网络中充当病原体的储库。
