Simulating the Spread and Control of Multiple MDROs Across a Network of Different Nursing Homes

摘要 项目3：模拟多个MDRO的传播和控制 在一个地区的养老院网络中 多重耐药微生物（MDRO）导致近300万例医疗相关感染（HAI）， 这是美国疗养院（NH）每年死亡的主要原因。虽然MDRO通常被研究 这些病原体孤立地同时传播，它们的传播和预防可能会影响 互相配合。因此，确定这些战略在NHS中的价值需要了解 它们将如何同时影响各种MDRO的定殖和感染风险。此外，影响 MDRO及其预防和控制战略超越了单个国家卫生机构， 一个地区的生态系统。将流行病学、操作和 经济成分可以帮助描述多个MDRO的循环和影响，测试各种 预防和控制战略，并确定随后的生态系统范围内的影响， 以节省时间、精力和资源的方式减少传播和疾病负担。这个项目的总体目标是 建议的项目是阐明（1）多个MDRO同时传播的综合效应 以及（2）政策和干预措施（例如，接触预防措施、非殖民化）可能会产生影响 同时跨多个MDRO，使用橙子中的NH的基于代理的模型（ABM 县（OC），加州（CA）。这些详细的NH表示将包括并帮助区分 影响MDRO传播的多层次因素中。这个建模项目将在一个协同， 与其他两个项目的迭代方式。模型结果将指导项目1的数据收集和分析 项目1和2的数据洞察将指导模型的进一步完善。重心下移 从一次一个MDRO到多个MDRO，将有助于决策者选择最佳方案 整体感染控制策略。具体目标1将为OC的70个护理NHS中的每一个制定ABM， CA模拟多个MDRO（耐甲氧西林金黄色葡萄球菌、耐万古霉素 产超广谱β-内酰胺酶肠球菌目，碳青霉烯类耐药 肠球菌和耳念珠菌）在携带者和共携带者之间相互作用以促进传播。具体目标 2将评估不同的病原体，宿主因素（例如，合并症、伤口、卧床状态）和房间 特性（例如，室友、公共区域、共用设备）同时影响MDRO 使用各种NH ABM跨区域的NH中的传输。具体目标3将估计各种 病原体特异性和非特异性多模式策略可能会影响不同病原体的传播和扩散。 使用NH ABM在整个区域的NH中单独和同时进行MDRO。

Abstract Project 3: Simulating the Spread and Control of Multiple MDROs Across a Network of Nursing Homes in a Region Multidrug-resistant organisms (MDROs) cause nearly 3 million healthcare-associated infections (HAIs), which are a major cause of death in US nursing homes (NHs), annually. While MDROs are commonly studied in isolation, these pathogens circulate simultaneously, and their spread and prevention may affect and compound each other. Therefore, determining the value of such strategies in NHs requires an understanding of how they would affect colonization and infection risks of various MDROs simultaneously. Moreover, the impact of MDROs and their prevention and control strategies extend beyond individual NHs and involve the dynamic ecosystem of NHs in a region. Computational modeling that integrates epidemiologic, operational, and economic components can help delineate the circulation and impact of multiple MDROs, test various prevention and control strategies, and determine the subsequent ecosystem-wide effects related to transmission and disease burden in ways that can save time, effort, and resources. The overall goal of this proposed project is to elucidate (1) the combined effects of multiple MDROs spreading simultaneously and (2) how policies and interventions (e.g., contact precautions, decolonization) may have an impact across a variety of MDROs at the same time, using agent-based models (ABMs) of NHs in Orange County (OC), California (CA). These detailed representations of NHs will include and help differentiate among various multi-level factors affecting MDRO spread. This modeling Project will proceed in a synergistic, iterative manner with the other two Projects. Model results will guide data collection and analyses for Projects 1 and 2, and data insights from Projects 1 and 2 will guide further refinement of the models. Shifting the focus from one MDRO at a time to various MDROs collectively will help decision makers choose the best overall infection control strategy. Specific Aim 1 will develop ABMs for each of the 70 nursing NHs in OC, CA simulating how multiple MDROs (methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales, and Candida auris) interact among carriers and co-carriers to promote spread. Specific Aim 2 will evaluate how different pathogens, host factors (e.g., comorbidities, wounds, bedbound status), and room characteristics (e.g., roommates, common areas, shared equipment) simultaneously affect MDRO transmission in NHs across a region using the various NH ABMs. Specific Aim 3 will estimate how various pathogen-specific and non-specific multi-modal strategies may affect the transmission and spread of different MDROs individually and simultaneously in NHs across a region using the NH ABMs.