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Modeling the regional spread and control of vancomycin-resistant enterococci.

  • Author(s): Lee, Bruce Y
  • Yilmaz, S Levent
  • Wong, Kim F
  • Bartsch, Sarah M
  • Eubank, Stephen
  • Song, Yeohan
  • Avery, Taliser R
  • Christie, Richard
  • Brown, Shawn T
  • Epstein, Joshua M
  • Parker, Jon I
  • Huang, Susan S
  • et al.


Because patients can remain colonized with vancomycin-resistant enterococci (VRE) for long periods of time, VRE may spread from one health care facility to another.


Using the Regional Healthcare Ecosystem Analyst, an agent-based model of patient flow among all Orange County, California, hospitals and communities, we quantified the degree and speed at which changes in VRE colonization prevalence in a hospital may affect prevalence in other Orange County hospitals.


A sustained 10% increase in VRE colonization prevalence in any 1 hospital caused a 2.8% (none to 62%) average relative increase in VRE prevalence in all other hospitals. Effects took from 1.5 to >10 years to fully manifest. Larger hospitals tended to have greater affect on other hospitals.


When monitoring and controlling VRE, decision makers may want to account for regional effects. Knowing a hospital's connections with other health care facilities via patient sharing can help determine which hospitals to include in a surveillance or control program.

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