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1 December 2005

Volume 192, Number 11
The Journal of Infectious Diseases 2005;192:2004–2011
© 2005 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2005/19211-0021$15.00
DOI: 10.1086/498041
MAJOR ARTICLE

A Mathematical Model Quantifying the Impact of Antibiotic Exposure and Other Interventions on the Endemic Prevalence of Vancomycin‐Resistant Enterococci

Erika M. C. D’Agata,1

Glenn Webb,2 and

MaryAnn Horn2

1Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; 2Department of Mathematics, Vanderbilt University, Nashville, Tennessee

Background.Mathematical modeling can be used to describe the interdependent and dynamic interactions that contribute to the transmission dynamics of vancomycin‐resistant enterococci (VRE). A model was developed to quantify the contribution of antibiotic exposure and of other modifiable factors to the dissemination of VRE in the hospital setting.

Methods.The model consists of 4 compartments: patients colonized with VRE receiving and not receiving antibiotics and uncolonized patients receiving and not receiving antibiotics. A series of differential equations describe the movement between these compartments. Baseline parameter estimates were obtained from pharmacy, infection‐control, and clinical databases.

Results.The main predictions of this model are that (1) preventing the initiation or enhancing the discontinuation of unnecessary antimicrobial therapy will have a greater impact if it is targeted to patients who are not colonized with VRE; (2) increasing the number of patients harboring VRE at the time of hospital admission substantially increases the endemic prevalence of VRE; and (3) eliminating the influx of VRE results in the eradication of this pathogen from the hospital. A decrease in the endemic prevalence of VRE also occurs with a decrease in the length of hospital stay of colonized patients, increased hand hygiene compliance, and a lower ratio of health‐care workers:patients.

Conclusion.This mathematical model provides a framework to assist in targeting necessary interventions aimed at limiting the spread of VRE.

Received 29 November 2004; accepted 14 June 2005; electronically published 31 October 2005.

Reprints or correspondence: Dr. Erika D’Agata, Beth Israel Deaconess Medical Center, Div. of Infectious Diseases, 330 Brookline Ave., East Campus Mailstop SL‐435G, Boston, MA 02215 ().

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Emma S. McBryde and Donald L. S. McElwain. (2006) A Mathematical Model Investigating the Impact of an Environmental Reservoir on the Prevalence and Control of Vancomycin‐Resistant Enterococci. The Journal of Infectious Diseases 193:10, 1473-1474
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  • Potential conflict of interest: E.M.C.D. has been a consultant and has received research funding from Genome Therapeutics.

    Financial support: Genome Therapeutics.

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