Modeling the transmission of community-associated methicillin-resistant Staphylococcus aureus: a dynamic agent-based simulation.
Modeling the transmission of community-associated methicillin-resistant Staphylococcus aureus: a dynamic agent-based simulation.
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对社区相关的耐甲氧西林金黄色葡萄球菌的传播进行建模：基于动态代理的模拟。
DOI：
10.1186/1479-5876-12-124
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发表时间：
2014-05-12
影响因子：
7.4
通讯作者：
Lauderdale DS
中科院分区：
文献类型：
--
作者：
Macal CM;North MJ;Collier N;Dukic VM;Wegener DT;David MZ;Daum RS;Schumm P;Evans JA;Wilder JR;Miller LG;Eells SJ;Lauderdale DS
自20世纪60年代以来，耐甲氧西林金黄色葡萄球菌（MRSA）一直是医疗保健环境中的致命病原体，但自1990年以来，MRSA流行病学发生了变化，新的遗传上不同的菌株类型在医疗保健环境以外的健康人群中传播。社区相关（CA）MRSA菌株主要引起皮肤和软组织感染，但也可能引起危及生命的侵入性感染。最早出现在澳大利亚和美国，这是一个在全世界日益严重的问题。美国有最广泛的CA-MRSA流行，其中USA 300型菌株引起绝大多数感染。具有无症状定植或感染的个体可能将CA-MRSA传播给他人，主要通过皮肤接触。控制措施的重点是医院传播。有限的公共卫生教育侧重于皮肤感染的护理。我们为芝加哥开发了一个细粒度的基于代理的模型，以确定在哪里进行干预以减少CA-MRSA传播。一个基于代理的模型使我们能够代表异质性的人口行为，位置和接触模式是高度相关的CA-MRSA的传播和控制。该模型利用全国代表性的调查数据，代表了社会人口统计学、地点、行为和身体接触模式的变化。传播概率基于全面的文献综述。在多个10年的运行与一小时的滴答声，我们的模型产生的时间和地理趋势CA-MRSA的发病率类似于芝加哥从2001年至2010年。平均而言，大多数传播事件发生在家庭中，绝大多数（95%以上）传播事件的来源是定植而不是感染的病原体。关键的发现是，感染者不是主要的传播源。相反，必须针对数量大得多的殖民地个体，以减少传播。我们的研究结果表明，目前在美国MRSA控制的范例不能非常有效地减少CA-MRSA感染的发病率。此外，集中在医院的控制措施不太可能对CA-MRSA率产生很大的人口影响。需要制定新的策略，因为CA-MRSA的发病率可能会在世界各地继续增长。
Methicillin-resistant Staphylococcus aureus (MRSA) has been a deadly pathogen in healthcare settings since the 1960s, but MRSA epidemiology changed since 1990 with new genetically distinct strain types circulating among previously healthy people outside healthcare settings. Community-associated (CA) MRSA strains primarily cause skin and soft tissue infections, but may also cause life-threatening invasive infections. First seen in Australia and the U.S., it is a growing problem around the world. The U.S. has had the most widespread CA-MRSA epidemic, with strain type USA300 causing the great majority of infections. Individuals with either asymptomatic colonization or infection may transmit CA-MRSA to others, largely by skin-to-skin contact. Control measures have focused on hospital transmission. Limited public health education has focused on care for skin infections. We developed a fine-grained agent-based model for Chicago to identify where to target interventions to reduce CA-MRSA transmission. An agent-based model allows us to represent heterogeneity in population behavior, locations and contact patterns that are highly relevant for CA-MRSA transmission and control. Drawing on nationally representative survey data, the model represents variation in sociodemographics, locations, behaviors, and physical contact patterns. Transmission probabilities are based on a comprehensive literature review. Over multiple 10-year runs with one-hour ticks, our model generates temporal and geographic trends in CA-MRSA incidence similar to Chicago from 2001 to 2010. On average, a majority of transmission events occurred in households, and colonized rather than infected agents were the source of the great majority (over 95%) of transmission events. The key findings are that infected people are not the primary source of spread. Rather, the far greater number of colonized individuals must be targeted to reduce transmission. Our findings suggest that current paradigms in MRSA control in the United States cannot be very effective in reducing the incidence of CA-MRSA infections. Furthermore, the control measures that have focused on hospitals are unlikely to have much population-wide impact on CA-MRSA rates. New strategies need to be developed, as the incidence of CA-MRSA is likely to continue to grow around the world.
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影响因子：
4.5
作者：
Fritz SA;Camins BC;Eisenstein KA;Fritz JM;Epplin EK;Burnham CA;Dukes J;Storch GA
通讯作者：
Storch GA
影响因子：
2.1
作者：
Barnes, Sean;Golden, Bruce;Wasil, Edward
通讯作者：
Wasil, Edward
影响因子：
2.1
作者：
Craig, BA;Sendi, PP
通讯作者：
Sendi, PP
影响因子：
158.5
作者：
BARRETT, FF;MCGEHEE, RF;FINLAND, M
通讯作者：
FINLAND, M
影响因子：
8.8
作者：
Hotchkiss, JR;Strike, DG;Crooke, PS
通讯作者：
Crooke, PS