title: Mathematical model of the impact of a nonantibiotic treatment for Clostridium difficile on the endemic prevalence of vancomycin-resistant enterococci in a hospital setting.
abstract: BACKGROUND
  Clostridium difficile-associated disease (CDAD) is treated using antibiotics, which often leads to the emergence of antibiotic-resistant bacteria such as vancomycin-resistant enterococci (VRE). This study estimated the impact of a non antibiotic treatment for CDAD on VRE prevalence.
  
  
  METHODS
  A previously published model describing the impact of in-hospital antibiotic use on VRE prevalence was adapted to include CDAD treatment. Simulations compared the prevalence of VRE when nonantibiotic versus antibiotic therapy was used.
  
  
  RESULTS
  Nonantibiotic treatment in 50% of CDAD patients resulted in an 18% relative reduction in the prevalence of VRE colonization compared with antibiotic use only. Sensitivity analysis found the model to be most sensitive to rates of antibiotic initiation and discontinuation, prevalence of VRE in admitted patients, length of stay of colonized patients, probability of CDAD acquisition, and hand-washing compliance.
  
  
  CONCLUSIONS
  Nonantibiotic treatment of patients hospitalized with CDAD may significantly reduce the incidence of VRE colonization.
authors.affiliation: Cornerstone Research Group Inc., Burlington, ON, Canada. dgrima@cornerstone-research.com
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Grima
authors.forename: Glenn F
authors.initials: GF
authors.lastname: Webb
authors.forename: Erika M C
authors.initials: EM
authors.lastname: D'Agata
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects*; D003198:Computer Simulation; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000382:microbiology*; D006761:Hospitals; D006801:Humans; D008954:Models, Biological; D015995:Prevalence; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents