Inference and control of the nosocomial transmission of methicillin-resistant Staphylococcus aureus

Elife. 2018 Dec 18;7:e40977. doi: 10.7554/eLife.40977.


Methicillin-resistant Staphylococcus aureus (MRSA) is a continued threat to human health in both community and healthcare settings. In hospitals, control efforts would benefit from accurate estimation of asymptomatic colonization and infection importation rates from the community. However, developing such estimates remains challenging due to limited observation of colonization and complicated transmission dynamics within hospitals and the community. Here, we develop an inference framework that can estimate these key quantities by combining statistical filtering techniques, an agent-based model, and real-world patient-to-patient contact networks, and use this framework to infer nosocomial transmission and infection importation over an outbreak spanning 6 years in 66 Swedish hospitals. In particular, we identify a small number of patients with disproportionately high risk of colonization. In retrospective control experiments, interventions targeted to these individuals yield a substantial improvement over heuristic strategies informed by number of contacts, length of stay and contact tracing.

Keywords: antibiotic-resistant pathogens; antimicrobial-resistant bacteria; computational biology; epidemiology; global health; methicillin-resistant Staphylococcus aureus; systems biology.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Biostatistics
  • Carrier State / epidemiology
  • Carrier State / microbiology
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Cross Infection / prevention & control
  • Cross Infection / transmission*
  • Disease Outbreaks*
  • Disease Transmission, Infectious / prevention & control*
  • Epidemiologic Methods
  • Hospitals
  • Humans
  • Infection Control / methods*
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification*
  • Retrospective Studies
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / prevention & control
  • Staphylococcal Infections / transmission*
  • Sweden / epidemiology