Probabilistic modelling of effects of antibiotics and calendar time on transmission of healthcare-associated infection

Bayesian Calibration to Address the Challenge of Antimicrobial Resistance: A Review

Antimicrobial resistance (AMR) emerges when disease-causing microorganisms develop the ability to withstand the effects of antimicrobial therapy. This phenomenon is often fueled by the human-to-human transmission of pathogens and the overuse of antibiotics. Over the past 50 years, increased computational power has facilitated the application of Bayesian inference algorithms. In this comprehensive review, the basic theory of Markov Chain Monte Carlo (MCMC) and Sequential Monte Carlo (SMC) methods are explained. These inference algorithms are instrumental in calibrating complex statistical models to the vast amounts of AMR-related data. Popular statistical models include hierarchical and mixture models as well as discrete and stochastic epidemiological compartmental and agent based models. Studies encompassed multi-drug resistance, economic implications of vaccines, and modeling AMR in vitro as well as within specific populations. We describe how combining these topics in a coherent framework can result in an effective antimicrobial stewardship. We also outline recent advancements in the methodology of Bayesian inference algorithms and provide insights into their prospective applicability for modeling AMR in the future.

Examining the impact of ICU population interaction structure on modeled colonization dynamics of Staphylococcus aureus

Background

Complex transmission models of healthcare-associated infections provide insight for hospital epidemiology and infection control efforts, but they are difficult to implement and come at high computational costs. Structuring more simplified models to incorporate the heterogeneity of the intensive care unit (ICU) patient-provider interactions, we explore how methicillin-resistant Staphylococcus aureus (MRSA) dynamics and acquisitions may be better represented and approximated.

Methods

Using a stochastic compartmental model of an 18-bed ICU, we compared the rates of MRSA acquisition across three ICU population interaction structures: a model with nurses and physicians as a single staff type (SST), a model with separate staff types for nurses and physicians (Nurse-MD model), and a Metapopulation model where each nurse was assigned a group of patients. The proportion of time spent with the assigned patient group (γ) within the Metapopulation model was also varied.

Results

The SST, Nurse-MD, and Metapopulation models had a mean of 40.6, 32.2 and 19.6 annual MRSA acquisitions respectively. All models were sensitive to the same parameters in the same direction, although the Metapopulation model was less sensitive. The number of acquisitions varied non-linearly by values of γ, with values below 0.40 resembling the Nurse-MD model, while values above that converged toward the Metapopulation structure.

Discussion

Inclusion of complex population interactions within a modeled hospital ICU has considerable impact on model results, with the SST model having more than double the acquisition rate of the more structured metapopulation model. While the direction of parameter sensitivity remained the same, the magnitude of these differences varied, producing different colonization rates across relatively similar populations. The non-linearity of the model’s response to differing values of a parameter gamma (γ) suggests simple model approximations are appropriate in only a narrow space of relatively dispersed nursing assignments.

Conclusion

Simplifying assumptions around how a hospital population is modeled, especially assuming random mixing, may overestimate infection rates and the impact of interventions. In many, if not most, cases more complex models that represent population mixing with higher granularity are justified.