Modeling the regional spread and control of vancomycin-resistant enterococci

• Published in: American journal of infection control 2013-08, Vol.41 (8), p.668-673
• Main Authors: Lee, Bruce Y., MD, MBA, Yilmaz, S. Levent, PhD, Wong, Kim F., PhD, Bartsch, Sarah M., MPH, Eubank, Stephen, PhD, Song, Yeohan, BS, Avery, Taliser R., MS, Christie, Richard, PhD, Brown, Shawn T., PhD, Epstein, Joshua M., PhD, Parker, Jon I., MS, Huang, Susan S., MD, MPH
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Bacterial infections; Biological and medical sciences; California - epidemiology; Computer Simulation; Cross Infection - epidemiology; Cross Infection - prevention & control; Cross Infection - transmission; Disease control; Drug resistance; Enterococcus - drug effects; Epidemiology. Vaccinations; General aspects; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - microbiology; Gram-Positive Bacterial Infections - prevention & control; Gram-Positive Bacterial Infections - transmission; Health care-associated infections; Hospitals; Human infectious diseases. Experimental studies and models; Humans; Infection Control; Infection Control - methods; Infectious Disease; Infectious diseases; Medical research; Medical sciences; Modeling; Nosocomial infections; Prevalence; Simulation; Vancomycin - pharmacology; Vancomycin Resistance - drug effects; Vancomycin-resistant Enterococcus
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2013.01.013

Background Because patients can remain colonized with vancomycin-resistant enterococci (VRE) for long periods of time, VRE may spread from one health care facility to another. Methods Using the Regional Healthcare Ecosystem Analyst, an agent-based model of patient flow among all Orange County, California, hospitals and communities, we quantified the degree and speed at which changes in VRE colonization prevalence in a hospital may affect prevalence in other Orange County hospitals. Results A sustained 10% increase in VRE colonization prevalence in any 1 hospital caused a 2.8% (none to 62%) average relative increase in VRE prevalence in all other hospitals. Effects took from 1.5 to >10 years to fully manifest. Larger hospitals tended to have greater affect on other hospitals. Conclusions When monitoring and controlling VRE, decision makers may want to account for regional effects. Knowing a hospital's connections with other health care facilities via patient sharing can help determine which hospitals to include in a surveillance or control program.