Titre : | Analysis of carbapenem-resistant Enterobacteriaceae outbreaks in the French healthcare network using mathematical modeling : Analyse des épidémies d'entérobactéries résistantes aus carbapenems sur le réseau des établissements de santé de France métropolitaine |
Auteurs : | Clément Massonnaud |
Type de document : | Mémoire |
Année de publication : | 2019 |
Description : | 43p. / ann., tabl., graph. |
Langues: | Français |
Classement : | MPH19/ (Master EHESP International master of public health - MPH) |
Mots-clés : | Epidémiologie ; Entérobactérie ; Epidémie ; Modèle mathématique ; Hôpital ; Transfert sanitaire ; Infection ; Risque ; Etablissement sanitaire ; France ; Etude ; Enquête épidémiologique |
Résumé : | Introduction. Carbapenemresistant Enterobacteriaceae (CRE) are spreading at an alarming rate, and threaten health systems and patient safety worldwide. However, data on the dynamics of CRE outbreaks is lacking, especially in France. This study aims at developing a mathematical model reproducing CRE outbreaks on the French network of healthcare facilities (HCF). Methods. We constructed the network of HCF of metropolitan France, over the years 2014-2016, using the national discharge database. We then developed a stochastic, hospitalbased, susceptible colonized infected model to reproduce the dynamics of CRE outbreaks across the 2015 network. It takes into accout, intrahospital dissemation, spreading by transfers, and importation from the community. We fitted the model on the 2015 surveillance data and performed simulations. Results. The network included 2,433 HCF for a maximum of 1,285,991 transfers recorded (2016). It was stable in its main characteristics over the three years and showed a high level of clustering. We estimated that the risk of infection after colonization by CRE in a healthcare setting was between 3.5% and 8.5%. We estimated a current level of detection of CRE episodes between 100% and 40% (1,209 undetected episodes). Assuming a baseline level of detection of 40%, we estimated that raising the level of detection up to 100% would only reduce the total number of episodes from 2,207 to 1,751 (20.7% reduction). Conclusions. This model suggests that patient transfer between HCF could play a critical role in the dynamics of CRE outbreaks. To our knowledge, this model is the first to study spread of pathogens in HCF on such a large scale. It could be a valuable tool for further research, and to help stakeholders in the management of the increasingly important issue of antimicrobial resistance. (R.A.) |
Diplôme : | Master MPH of public health |
Plan de classement simplifié : | Master of Public Health - master international de Santé Public (MPH) |
En ligne : | http://documentation.ehesp.fr/memoires/2019/mph/Clément MASSONNAUD.pdf |
Exemplaires (1)
Code-barres | Cote | Support | Localisation | Section | Disponibilité |
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098060 | MPH19/0003 | Mémoire | Rennes | Magasin | Empruntable Disponible |
Documents numériques (1)
MPH/massonnaud URL |