Modeling the impact of interventions against Acinetobacter baumannii transmission in intensive care units

Doan, Tan N., Kong, David C.M., Marshall, Caroline, Kirkpatrick, Carl M.J., and McBryde, Emma S. (2016) Modeling the impact of interventions against Acinetobacter baumannii transmission in intensive care units. Virulence, 7 (2). pp. 141-152.

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The efficacy of infection control interventions against Acinetobacter baumannii remains unclear, despite such information being critical for effective prevention of the transmission of this pathogen. Mathematical modeling offers an alternative to clinical trials, which may be prohibitively expensive, unfeasible or unethical, in predicting the impact of interventions. Furthermore, it allows the ability to ask key "what if" questions to evaluate which interventions have the most impact. We constructed a transmission dynamic model to quantify the effects of interventions on reducing A. baumannii prevalence and the basic reproduction ratio (R0) in intensive care units (ICUs). We distinguished between colonization and infection, and incorporated antibiotic exposure and transmission from free-living bacteria in the environment. Under the assumptions and parameterization in our model, 25% and 18% of patients are colonized and infected with A. baumannii, respectively; and R0 is 1.4. Improved compliance with hand hygiene (≥87%), enhanced environmental cleaning, reduced length of ICU stay of colonized patients (≤ 10 days), shorter durations of antibiotic treatment of A. baumannii (≤6 days), and isolation of infected patients combined with cleaning of isolation rooms are effective, reducing R0 to below unity. In contrast, expediting the recovery of the intestinal microbiota (e.g. use of probiotics) is not effective. This study represents a biologically realistic model of the transmission dynamics of A. baumannii, and the most comprehensive analysis of the effectiveness of interventions against this pathogen. Our study provides important data for designing effective infection control interventions.

Item ID: 42205
Item Type: Article (Research - C1)
ISSN: 2150-5608
Keywords: Acinetobacter baumannii; infection control; intensive care units; mathematical modeling; transmission dynamics
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This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted.

Funders: Monash University (MU), National Health and Medical Research Council (NHMRC)
Date Deposited: 29 Apr 2016 05:23
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320211 Infectious diseases @ 40%
42 HEALTH SCIENCES > 4202 Epidemiology > 420205 Epidemiological modelling @ 40%
44 HUMAN SOCIETY > 4407 Policy and administration > 440706 Health policy @ 20%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 50%
92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 50%
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