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    Modeling the impact of interventions against Acinetobacter baumannii transmission in intensive care units

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    14
    Author
    Doan, TN; Kong, DCM; Marshall, C; Kirkpatrick, CMJ; McBryde, ES
    Date
    2016-02-17
    Source Title
    Virulence
    Publisher
    TAYLOR & FRANCIS INC
    University of Melbourne Author/s
    Marshall, Caroline; McBryde, Emma
    Affiliation
    Medicine and Radiology
    Metadata
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    Document Type
    Journal Article
    Citations
    Doan, T. N., Kong, D. C. M., Marshall, C., Kirkpatrick, C. M. J. & McBryde, E. S. (2016). Modeling the impact of interventions against Acinetobacter baumannii transmission in intensive care units. VIRULENCE, 7 (2), pp.141-152. https://doi.org/10.1080/21505594.2015.1076615.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/260359
    DOI
    10.1080/21505594.2015.1076615
    Abstract
    The efficacy of infection control interventions against Acinetobacter baumannii remains unclear, despite such information being critical for effective prevention of the transmission of this pathogen. Mathematical modeling offers an alternative to clinical trials, which may be prohibitively expensive, unfeasible or unethical, in predicting the impact of interventions. Furthermore, it allows the ability to ask key "what if" questions to evaluate which interventions have the most impact. We constructed a transmission dynamic model to quantify the effects of interventions on reducing A. baumannii prevalence and the basic reproduction ratio (R0) in intensive care units (ICUs). We distinguished between colonization and infection, and incorporated antibiotic exposure and transmission from free-living bacteria in the environment. Under the assumptions and parameterization in our model, 25% and 18% of patients are colonized and infected with A. baumannii, respectively; and R0 is 1.4. Improved compliance with hand hygiene (≥87%), enhanced environmental cleaning, reduced length of ICU stay of colonized patients (≤ 10 days), shorter durations of antibiotic treatment of A. baumannii (≤6 days), and isolation of infected patients combined with cleaning of isolation rooms are effective, reducing R0 to below unity. In contrast, expediting the recovery of the intestinal microbiota (e.g. use of probiotics) is not effective. This study represents a biologically realistic model of the transmission dynamics of A. baumannii, and the most comprehensive analysis of the effectiveness of interventions against this pathogen. Our study provides important data for designing effective infection control interventions.

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