'The Graduate School of the Humanities, Utrecht University'
Abstract
In Part I we discuss models for the spread of nosocomial antibioticresistant
bacteria. We focus on pathogens for which re-admission of
colonized individuals is important, i.e., the feedback-loop between the
hospital and the extramural population. In Chapter 2 we will discuss
an analytical model and in Chapter 3 we will focus on colonization with
Methicillin-resistant Staphylococcus aureus (MRSA). We use both an analytical
and a simulation model. Both models suggest that isolation of
identified carriers of MRSA in hospitals combined with either screening
on admission of high-risk patient or the screening of contact patients in
case of the identification of an unexpected MRSA carrier in the hospital,
may be sufficient to prevent high levels of MRSA in the hospitals.
However, the so-called Dutch search and destroy policy in which both
interventions are applied ensures that the current low prevalence level
of MRSA in the Netherlands is far less sensitive to changes in the parameter
values.
In Part II we use real hospital data to draw conclusions for specific
pathogens/diseases. In Chapter 4 we use a simple observation to
disentangle the phenomena that patients who acquire an infection are
likely to stay longer in a unit and that patients who stay longer in a
unit are more likely to acquire an infection. In Chapter 5 we use likelihood
methods in a Markov chain approach to distinguish between
different infection routes on the basis of the fluctuations in the prevalence.
This method is applied to data for colonization with two different
pathogens. This method is also used to determine optimal culture
frequencies
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