Identifying asymptomatic spreaders of antimicrobial-resistant pathogens in hospital settings
Identifying asymptomatic spreaders of antimicrobial-resistant pathogens in hospital settings
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DOI：
10.1073/pnas.2111190118
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发表时间：
2021-09-14
影响因子：
11.1
通讯作者：
Shaman, Jeffrey
中科院分区：
文献类型：
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作者：
Pei, Sen;Liljeros, Fredrik;Shaman, Jeffrey
抗微生物耐药生物（AMRO）可以在没有症状的人群中长时间定植，在此期间，这些病原体可以在医疗系统中不被注意地传播给其他患者。在医院环境中准确识别AMRO无症状传播者对于支持针对卫生保健相关感染（HAI）的干预措施的设计至关重要。然而，这项任务仍然具有挑战性，因为对医院和更广泛社区内发生的殖民化和复杂的传播动态的观察有限。在这里，我们研究了耐甲氧西林金黄色葡萄球菌（MRSA）的传播，这是一种流行的AMRO，在66家瑞典医院和医疗机构中，使用数据驱动的，基于代理的模型，通过去识别的真实世界住院记录来了解住院患者。结合传播模型，病人到病人的接触网络，和稀疏的殖民观察，我们开发和验证individuallevel推理方法，估计个别住院患者的殖民概率。对于模型模拟和历史爆发，所提出的方法支持比其他传统方法更准确地识别无症状MRSA携带者。此外，在二氧化硅控制实验表明，针对具有高定植概率的住院患者的干预措施优于由住院史和接触者追踪所告知的启发式策略。
Antimicrobial-resistant organisms (AMROs) can colonize people without symptoms for long periods of time, during which these agents can spread unnoticed to other patients in healthcare systems. The accurate identification of asymptomatic spreaders of AMRO in hospital settings is essential for supporting the design of interventions against healthcare-associated infections (HAIs). However, this task remains challenging because of limited observations of colonization and the complicated transmission dynamics occurring within hospitals and the broader community. Here, we study the transmission of methicillin-resistant Staphylococcus aureus (MRSA), a prevalent AMRO, in 66 Swedish hospitals and healthcare facilities with inpatients using a data-driven, agent-based model informed by deidentified real-world hospitalization records. Combining the transmission model, patient-to-patient contact networks, and sparse observations of colonization, we develop and validate an individuallevel inference approach that estimates the colonization probability of individual hospitalized patients. For both model-simulated and historical outbreaks, the proposed method supports the more accurate identification of asymptomatic MRSA carriers than other traditional approaches. In addition, in silica control experiments indicate that interventions targeted to inpatients with a high-colonization probability outperform heuristic strategies informed by hospitalization history and contact tracing.