BMC Infectious Diseases | |
Modelling the transmission of healthcare associated infections: a systematic review | |
William J Edmunds2  Sarah R Deeny1  Mark Jit1  Julie V Robotham1  Esther van Kleef1  | |
[1] Modelling and Economics unit, Public Health England, Colindale, London, UK;Infectious Disease Epidemiology Department, Faculty of Epidemiology and Population Health, Centre of Mathematical Modelling, London School of Hygiene and Tropical Medicine, London, UK | |
关键词: Epidemiology; Healthcare-associated infections; Mathematical modelling; | |
Others : 1147510 DOI : 10.1186/1471-2334-13-294 |
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received in 2012-11-29, accepted in 2013-06-21, 发布年份 2013 | |
【 摘 要 】
Background
Dynamic transmission models are increasingly being used to improve our understanding of the epidemiology of healthcare-associated infections (HCAI). However, there has been no recent comprehensive review of this emerging field. This paper summarises how mathematical models have informed the field of HCAI and how methods have developed over time.
Methods
MEDLINE, EMBASE, Scopus, CINAHL plus and Global Health databases were systematically searched for dynamic mathematical models of HCAI transmission and/or the dynamics of antimicrobial resistance in healthcare settings.
Results
In total, 96 papers met the eligibility criteria. The main research themes considered were evaluation of infection control effectiveness (64%), variability in transmission routes (7%), the impact of movement patterns between healthcare institutes (5%), the development of antimicrobial resistance (3%), and strain competitiveness or co-colonisation with different strains (3%). Methicillin-resistant Staphylococcus aureus was the most commonly modelled HCAI (34%), followed by vancomycin resistant enterococci (16%). Other common HCAIs, e.g. Clostridum difficile, were rarely investigated (3%). Very few models have been published on HCAI from low or middle-income countries.
The first HCAI model has looked at antimicrobial resistance in hospital settings using compartmental deterministic approaches. Stochastic models (which include the role of chance in the transmission process) are becoming increasingly common. Model calibration (inference of unknown parameters by fitting models to data) and sensitivity analysis are comparatively uncommon, occurring in 35% and 36% of studies respectively, but their application is increasing. Only 5% of models compared their predictions to external data.
Conclusions
Transmission models have been used to understand complex systems and to predict the impact of control policies. Methods have generally improved, with an increased use of stochastic models, and more advanced methods for formal model fitting and sensitivity analyses. Insights gained from these models could be broadened to a wider range of pathogens and settings. Improvements in the availability of data and statistical methods could enhance the predictive ability of models.
【 授权许可】
2013 van Kleef et al.; licensee BioMed Central Ltd.
【 预 览 】
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