A systematic review of transmission dynamic studies of methicillin-resistant Staphylococcus aureus in non-hospital residential facilities

被引:17
作者
Kwok, Kin On [1 ,2 ,3 ]
Read, Jonathan M. [4 ,5 ]
Tang, Arthur [6 ]
Chen, Hong [7 ]
Riley, Steven [8 ]
Kam, Kai Man [1 ,2 ]
机构
[1] Chinese Univ Hong Kong, Jockey Club Sch Publ Hlth & Primary Care, Shatin, Hong Kong, Peoples R China
[2] Chinese Univ Hong Kong, Stanley Ho Ctr Emerging Infect Dis, Shatin, Hong Kong, Peoples R China
[3] Chinese Univ Hong Kong, Shenzhen Res Inst, Shenzhen, Peoples R China
[4] Univ Lancaster, Ctr Hlth Informat Comp & Stat, Lancaster Med Sch, Fac Hlth & Med, Lancaster, England
[5] Univ Liverpool, Inst Infect & Global Hlth, Farr Inst HeRC, Liverpool, Merseyside, England
[6] Sungkyunkwan Univ, Dept Software, Seoul, South Korea
[7] Ctr Hlth Protect, Hong Kong, Hong Kong, Peoples R China
[8] Imperial Coll London, Dept Infect Dis Epidemiol, MRC Ctr Outbreak Anal & Modelling, London, England
基金
英国医学研究理事会; 英国惠康基金; 英国工程与自然科学研究理事会;
关键词
Methicillin-resistant Staphylococcus aureus; MRSA; Transmission models; Non-hospital; Residential; LENGTH-OF-STAY; INFECTION-CONTROL; NURSING-HOMES; ORANGE-COUNTY; CARE; COMMUNITY; COLONIZATION; EPIDEMIOLOGY; MRSA; ACQUISITION;
D O I
10.1186/s12879-018-3060-6
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: Non-hospital residential facilities are important reservoirs for MRSA transmission. However, conclusions and public health implications drawn from the many mathematical models depicting nosocomial MRSA transmission may not be applicable to these settings. Therefore, we reviewed the MRSA transmission dynamics studies in defined non-hospital residential facilities to: (1) provide an overview of basic epidemiology which has been addressed; (2) identify future research direction; and (3) improve future model implementation. Methods: A review was conducted by searching related keywords in PUBMED without time restriction as well as internet searches via Google search engine. We included only articles describing the epidemiological transmission pathways of MRSA/community-associated MRSA within and between defined non-hospital residential settings. Results: Among the 10 included articles, nursing homes (NHs) and correctional facilities (CFs) were two settings considered most frequently. Importation of colonized residents was a plausible reason for MRSA outbreaks in NHs, where MRSA was endemic without strict infection control interventions. The importance of NHs over hospitals in increasing nosocomial MRSA prevalence was highlighted. Suggested interventions in NHs included: appropriate staffing level, screening and decolonizing, and hand hygiene. On the other hand, the small population amongst inmates in CFs has no effect on MRSA community transmission. Included models ranged from system-level compartmental models to agent-based models. There was no consensus over the course of disease progression in these models, which were mainly featured with NH residents /CF inmates/ hospital patients as transmission pathways. Some parameters used by these models were outdated or unfit. Conclusions: Importance of NHs has been highlighted from these current studies addressing scattered aspects of MRSA epidemiology. However, the wide variety of non-hospital residential settings suggest that more work is needed before robust conclusions can be drawn. Learning from existing work for hospitals, we identified critical future research direction in this area from infection control, ecological and economic perspectives. From current model deficiencies, we suggest more transmission pathways be specified to depict MRSA transmission, and further empirical studies be stressed to support evidence-based mathematical models of MRSA in non-hospital facilities. Future models should be ready to cope with the aging population structure.
引用
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页数:13
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