BACKGROUND The Centers for Disease Control and Prevention (CDC) recently published interim guidance for a public health response to contain novel or targeted multidrug-resistant organisms (MDROs). We assessed the impact of implementing the strategy in a US state using a mathematical model. METHODS We used a deterministic compartmental model, parametrized via a novel analysis of carbapenem-resistant Enterobacteriaceae data reported to the National Healthcare Safety Network and patient transfer data from the Centers for Medicare and Medicaid Services. The simulations assumed that after the importation of the MDRO and its initial detection by clinical culture at an index hospital, fortnightly prevalence surveys for colonization and additional infection control interventions were implemented at the index facility; similar surveys were then also implemented at those facilities known to be connected most strongly to it as measured by patient transfer data; and prevalence surveys were discontinued after 2 consecutive negative surveys. RESULTS If additional infection-control interventions are assumed to lead to a 20% reduction in transmissibility in intervention facilities, prevalent case count in the state 3 years after importation would be reduced by 76% (interquartile range: 73-77%). During the third year, these additional infection-control measures would be applied in facilities accounting for 42% (37-46%) of inpatient days. CONCLUSIONS CDC guidance for containing MDROs, when used in combination with information on transfer of patients among hospitals, is predicted to be effective, enabling targeted and efficient use of prevention resources during an outbreak response. Even modestly effective infection-control measures may lead to a substantial reduction in transmission events.

中文翻译：

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建模与医疗保健相关的多药耐药生物的区域传播和遏制。

背景技术疾病控制和预防中心（CDC）最近发布了关于公共卫生应对措施的临时指南，其中应包含新型或靶向的多药耐药生物（MDRO）。我们使用数学模型评估了在美国州实施该策略的影响。方法我们使用了确定性的隔室模型，该模型是通过对向国家医疗安全网络报告的耐碳青霉烯的肠杆菌科细菌数据和来自医疗保险和医疗补助服务中心的患者转移数据进行新颖分析而参数化的。模拟假设在输入MDRO并在索引医院通过临床培养对其进行初步检测后，在索引设施中每两周进行一次定殖流行率调查和其他感染控制干预措施；然后，在那些根据患者转移数据测量出的已知最紧密联系的设施上，也进行了类似的调查；在进行了两次连续的负面调查后，调查中断了流行率调查。结果如果假设其他感染控制干预措施可以使干预设施的传染性降低20％，则在进口后3年内该州的流行病例数将减少76％（四分位数范围：73-77％）。在第三年中，这些额外的感染控制措施将应用于占住院天数42％（37-46％）的设施中。结论包含MDRO的CDC指南与医院之间的患者转移信息结合使用时，预计是有效的，在疫情应对期间能够有针对性地有效利用预防资源。甚至适度有效的感染控制措施也可能导致传播事件的大幅减少。