title: Parameters for the mathematical modelling of Clostridium difficile acquisition and transmission: a systematic review.
abstract: BACKGROUND
  Mathematical modelling of Clostridium difficile infection dynamics could contribute to the optimisation of strategies for its prevention and control. The objective of this systematic review was to summarise the available literature specifically identifying the quantitative parameters required for a compartmental mathematical model of Clostridium difficile transmission.
  
  
  METHODS
  Six electronic healthcare databases were searched and all screening, data extraction and study quality assessments were undertaken in duplicate. Results were synthesised using a narrative approach.
  
  
  RESULTS
  Fifty-four studies met the inclusion criteria. Reproduction numbers for hospital based epidemics were described in two studies with a range from 0.55 to 7. Two studies provided consistent data on incubation periods. For 62% of cases, symptoms occurred in less than 4 weeks (3-28 days) after infection. Evidence on contact patterns was identified in four studies but with limited data reported for populating a mathematical model. Two studies, including one without clinically apparent donor-recipient pairs, provided information on serial intervals for household or ward contacts, showing transmission intervals of <1 week in ward based contacts compared to up to 2 months for household contacts. Eight studies reported recovery rates of between 75%-100% for patients who had been treated with either metronidazole or vancomycin. Forty-nine studies gave recurrence rates of between 3% and 49% but were limited by varying definitions of recurrence. No study was found which specifically reported force of infection or net reproduction numbers.
  
  
  CONCLUSIONS
  There is currently scant literature overtly citing estimates of the parameters required to inform the quantitative modelling of Clostridium difficile transmission. Further high quality studies to investigate transmission parameters are required, including through review of published epidemiological studies where these quantitative estimates may not have been explicitly estimated, but that nonetheless contain the relevant data to allow their calculation.
authors.affiliation: School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Eroboghene H
authors.initials: EH
authors.lastname: Otete
authors.affiliation: School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Anand S
authors.initials: AS
authors.lastname: Ahankari
authors.affiliation: School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Jones
authors.affiliation: Melbourne School of Population and Global Health , University of Melbourne, Melbourne, Australia ; School of Mathematical Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Kirsty J
authors.initials: KJ
authors.lastname: Bolton
authors.affiliation: NHS England Area Team Derbyshire, Nottingham and Nottinghamshire, United Kingdom.
authors.forename: Caroline W
authors.initials: CW
authors.lastname: Jordan
authors.affiliation: Department of Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
authors.forename: Tim C
authors.initials: TC
authors.lastname: Boswell
authors.affiliation: Department of Microbiology, University of Leeds, Leeds, United Kingdom.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wilcox
authors.affiliation: School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Ferguson
authors.affiliation: School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Beck
authors.affiliation: School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Puleston
mesh_terms: D016360:Clostridioides difficile; D016358:Contact Tracing; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D055256:Infectious Disease Incubation Period; D008954:Models, Biological; D012008:Recurrence