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Identifying conditions for elimination and epidemic potential of methicillin-resistant Staphylococcus aureus in nursing homes
BACKGROUND: Residents of nursing homes are commonly colonized with methicillin-resistant Staphylococcus aureus (MRSA) but there is a limited understanding of the dynamics and determinants of spread in this setting. To address this gap, we sought to use mathematical modeling to assess the epidemic po...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034495/ https://www.ncbi.nlm.nih.gov/pubmed/27688877 http://dx.doi.org/10.1186/s13756-016-0130-7 |
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author | Batina, Nataliya G. Crnich, Christopher J. Anderson, David F. Döpfer, Dörte |
author_facet | Batina, Nataliya G. Crnich, Christopher J. Anderson, David F. Döpfer, Dörte |
author_sort | Batina, Nataliya G. |
collection | PubMed |
description | BACKGROUND: Residents of nursing homes are commonly colonized with methicillin-resistant Staphylococcus aureus (MRSA) but there is a limited understanding of the dynamics and determinants of spread in this setting. To address this gap, we sought to use mathematical modeling to assess the epidemic potential of MRSA in nursing homes and to determine conditions under which non-USA300 and USA300 MRSA could be eliminated or reduced in the facilities. METHODS: Model parameters were estimated from data generated during a longitudinal study of MRSA in 6 Wisconsin nursing homes. The data included subject colonization status with strain-specific MRSA collected every 3 months for up to 1 year. Deterministic and stochastic co-colonization and single-strain models were developed to describe strain-specific dynamics of MRSA in these facilities. Basic reproduction numbers of strain-independent MRSA, non-USA300 and USA300 MRSA were estimated numerically. The impact of antibiotic use in the past 3 months on the prevalence of strain-specific MRSA and associated basic reproduction numbers were evaluated. RESULTS: Our models predicted that MRSA would persist in Wisconsin nursing homes, and non-USA300 would remain the dominant circulating strain. MRSA eradication was theoretically achievable by elimination of MRSA-positive admissions over the course of years. Substantial reductions in MRSA prevalence could be attained through marked increase in clearance rates or reduction in MRSA-positive admissions sustained over years. The basic reproduction number of strain-independent MRSA was 0.18 (95 % CI = 0.13–0.23). Recent antibiotic use increased the prevalence of strain-specific MRSA and associated basic reproduction numbers, but was unlikely to lead to an outbreak. CONCLUSIONS: Based on our model, MRSA elimination from nursing homes, while theoretically possible, was unlikely to be achieved in practice. Decolonization therapy that can sustain higher clearance rates or lower MRSA-positive introductions over years may reduce strain-specific prevalence of MRSA in the facilities, and antibiotic stewardship may contribute to this effort. Large-scale MRSA outbreaks were unlikely in this setting. |
format | Online Article Text |
id | pubmed-5034495 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-50344952016-09-29 Identifying conditions for elimination and epidemic potential of methicillin-resistant Staphylococcus aureus in nursing homes Batina, Nataliya G. Crnich, Christopher J. Anderson, David F. Döpfer, Dörte Antimicrob Resist Infect Control Research BACKGROUND: Residents of nursing homes are commonly colonized with methicillin-resistant Staphylococcus aureus (MRSA) but there is a limited understanding of the dynamics and determinants of spread in this setting. To address this gap, we sought to use mathematical modeling to assess the epidemic potential of MRSA in nursing homes and to determine conditions under which non-USA300 and USA300 MRSA could be eliminated or reduced in the facilities. METHODS: Model parameters were estimated from data generated during a longitudinal study of MRSA in 6 Wisconsin nursing homes. The data included subject colonization status with strain-specific MRSA collected every 3 months for up to 1 year. Deterministic and stochastic co-colonization and single-strain models were developed to describe strain-specific dynamics of MRSA in these facilities. Basic reproduction numbers of strain-independent MRSA, non-USA300 and USA300 MRSA were estimated numerically. The impact of antibiotic use in the past 3 months on the prevalence of strain-specific MRSA and associated basic reproduction numbers were evaluated. RESULTS: Our models predicted that MRSA would persist in Wisconsin nursing homes, and non-USA300 would remain the dominant circulating strain. MRSA eradication was theoretically achievable by elimination of MRSA-positive admissions over the course of years. Substantial reductions in MRSA prevalence could be attained through marked increase in clearance rates or reduction in MRSA-positive admissions sustained over years. The basic reproduction number of strain-independent MRSA was 0.18 (95 % CI = 0.13–0.23). Recent antibiotic use increased the prevalence of strain-specific MRSA and associated basic reproduction numbers, but was unlikely to lead to an outbreak. CONCLUSIONS: Based on our model, MRSA elimination from nursing homes, while theoretically possible, was unlikely to be achieved in practice. Decolonization therapy that can sustain higher clearance rates or lower MRSA-positive introductions over years may reduce strain-specific prevalence of MRSA in the facilities, and antibiotic stewardship may contribute to this effort. Large-scale MRSA outbreaks were unlikely in this setting. BioMed Central 2016-09-22 /pmc/articles/PMC5034495/ /pubmed/27688877 http://dx.doi.org/10.1186/s13756-016-0130-7 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Batina, Nataliya G. Crnich, Christopher J. Anderson, David F. Döpfer, Dörte Identifying conditions for elimination and epidemic potential of methicillin-resistant Staphylococcus aureus in nursing homes |
title | Identifying conditions for elimination and epidemic potential of methicillin-resistant Staphylococcus aureus in nursing homes |
title_full | Identifying conditions for elimination and epidemic potential of methicillin-resistant Staphylococcus aureus in nursing homes |
title_fullStr | Identifying conditions for elimination and epidemic potential of methicillin-resistant Staphylococcus aureus in nursing homes |
title_full_unstemmed | Identifying conditions for elimination and epidemic potential of methicillin-resistant Staphylococcus aureus in nursing homes |
title_short | Identifying conditions for elimination and epidemic potential of methicillin-resistant Staphylococcus aureus in nursing homes |
title_sort | identifying conditions for elimination and epidemic potential of methicillin-resistant staphylococcus aureus in nursing homes |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034495/ https://www.ncbi.nlm.nih.gov/pubmed/27688877 http://dx.doi.org/10.1186/s13756-016-0130-7 |
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