ABSTRACT
BACKGROUND: While antimicrobial resistance threatens the prevention, treatment, and control of infectious diseases, systematic analysis of routine microbiology laboratory test results worldwide can alert new threats and promote timely response. This study explores statistical algorithms for recognizing geographic clustering of multi-resistant microbes within a healthcare network and monitoring the dissemination of new strains over time. METHODS: Escherichia coli antimicrobial susceptibility data from a three-year period stored in WHONET were analyzed across ten facilities in a healthcare network utilizing SaTScan's spatial multinomial model with two models for defining geographic proximity. We explored geographic clustering of multi-resistance phenotypes within the network and changes in clustering over time. RESULTS: Geographic clustering identified from both latitude/longitude and non-parametric facility groupings geographic models were similar, while the latter was offers greater flexibility and generalizability. Iterative application of the clustering algorithms suggested the possible recognition of the initial appearance of invasive E. coli ST131 in the clinical database of a single hospital and subsequent dissemination to others. CONCLUSION: Systematic analysis of routine antimicrobial resistance susceptibility test results supports the recognition of geographic clustering of microbial phenotypic subpopulations with WHONET and SaTScan, and iterative application of these algorithms can detect the initial appearance in and dissemination across a region prompting early investigation, response, and containment measures.
Subject(s)
Cross Infection/epidemiology , Disease Outbreaks/statistics & numerical data , Drug Resistance, Bacterial , Escherichia coli Infections/epidemiology , Escherichia coli Infections/microbiology , Escherichia coli/isolation & purification , Models, Theoretical , Algorithms , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Cluster Analysis , Cross Infection/microbiology , Cross Infection/prevention & control , Cross-Sectional Studies , Disease Outbreaks/prevention & control , Escherichia coli/drug effects , Escherichia coli Infections/drug therapy , Escherichia coli Infections/prevention & control , Geography , Humans , Microbial Sensitivity TestsABSTRACT
Current recommendations have not resulted in routine vaccination of correctional facility inmates for hepatitis B. We investigated two hepatitis B outbreaks. Outbreak 1 involved 4 cases epidemiologically linked to persons who had been in jail. Outbreak 2 involved 48 community cases; 69% had a history of incarceration. Two-thirds of the cases in these outbreaks might have been prevented by a program of routine vaccination of local jail inmates. Priority should be given to developing and supporting practical programs to vaccinate the high-risk populations in correctional facilities against hepatitis B.
