Institute of Applied Mathematics and Mechanics, University of Warsaw, Poland.
Institute of Applied Mathematics and Mechanics, University of Warsaw, Poland.
Clin Microbiol Infect. 2023 Jan;29(1):109.e1-109.e7. doi: 10.1016/j.cmi.2022.08.001. Epub 2022 Aug 12.
The introduction of multi-drug-resistant Enterobacteriaceae (MDR-E) by colonized patients transferred from high-prevalence countries has led to several large outbreaks of MDR-E in low-prevalence countries, with the risk of propagated spread to the community. The goal of this study was to derive a strategy to counteract the spread of MDR-E at the regional health-care network level.
We used a hybrid ordinary differential equation and network model built based on German health insurance data to evaluate whether the re-direction of patient flow in combination with targeted infection control measures can counteract the spread of MDR-E in the German health-care system. We applied pragmatic re-direction strategies focusing on a reduced choice of hospitals for subsequent stays after initial hospitalization but not manipulating direct transfers because these are most likely determined by medical needs.
The re-direction strategies alone did not reduce the system-wide spread of MDR-E (system-wide prevalence of MDR-E is 18.7% vs. 25.7%/29.9%). In contrast, targeted hospital-based infection control measures restricted to institutions with the highest institutional basic reproduction numbers in the network were identified as an effective tool for reducing system-wide prevalence (system-wide prevalence of MDR-E is 18.7% vs. 9.3%). If these measures were applied to the top one-third of hospitals, the system-wide prevalence could be reduced by approximately 80% (system-wide prevalence of 18.7% vs. 3.5% for one-third of patients subjected to interventions). A combination of this hospital-based intervention and patient re-direction strategies could not improve the effectiveness of the hospital-based approach (system-wide prevalence of MDR-E is 9.3% vs. 14.2%/14.3%).
The pragmatic patient re-direction strategies were not capable of restricting the spread of MDR-E in a simulation of the German health-care system; in contrast, hospital-based interventions focusing on institutions identified based on network transmission patterns seem to be a promising approach for sustainable reduction of the spread of MDR-E through the German population.
定植于患者的多重耐药肠杆菌科（MDR-E）被转移至高流行国家，导致低流行国家发生了几起 MDR-E 大规模暴发，且存在传播至社区的风险。本研究旨在制定一项在区域卫生保健网络层面上对抗 MDR-E 传播的策略。
我们使用了一种基于德国健康保险数据建立的混合常微分方程和网络模型，以评估患者流动方向的调整与有针对性的感染控制措施相结合是否可以在德国卫生保健系统中阻止 MDR-E 的传播。我们应用了实用的重新定向策略，重点减少患者在初次住院后的后续住院医院的选择，但不操纵直接转院，因为这些转院很可能是由医疗需求决定的。
仅重新定向策略并不能减少 MDR-E 在整个系统中的传播（MDR-E 在整个系统中的流行率为 18.7%，而 25.7%/29.9%）。相比之下，仅针对网络中机构基本繁殖数最高的机构进行的基于医院的有针对性的感染控制措施被确定为降低整个系统流行率的有效工具（MDR-E 在整个系统中的流行率为 18.7%，而 9.3%）。如果将这些措施应用于前 1/3 的医院，整个系统的流行率可降低约 80%（整个系统的流行率为 18.7%，而接受干预的 1/3 患者的流行率为 3.5%）。将这种基于医院的干预措施与患者重新定向策略相结合，无法提高基于医院的方法的效果（MDR-E 在整个系统中的流行率为 9.3%，而 14.2%/14.3%）。
实用的患者重新定向策略在德国卫生保健系统模拟中无法限制 MDR-E 的传播；相比之下，基于网络传播模式确定机构的基于医院的干预措施似乎是通过德国人群可持续减少 MDR-E 传播的一种有希望的方法。
