title: [Analysis of patient flows: basis for regional control of antibiotic resistance].
abstract: Antibiotic resistance is a worldwide threat to health care as it impairs the effective treatment of bacterial infections. Measures against the spread of resistance are mainly focused on individual health care institutions as these are viewed as the main source of resistance. However, health care institutions are not completely independent in their control of the prevalence of resistance, as movement of patients between hospitals and care institutions can induce movement of resistant micro-organisms. In other words, antibiotic resistance follows the flow of patients. Mapping this flow of patients results in a network that includes all health care institutions, and has a distinctive modular structure. Patients are moved primarily within regions, much less so between regions. We argue that the structure of this health care network should be used to design efficient and effective control strategies. To this end, we advocate (a) regional coordination of control measures, (b) differentiation of investment in infection prevention according to the network position of the institution, and
authors.affiliation: Rijksuniversiteit Groningen/Universitair Medisch Centrum Groningen, afd. Medische Microbiologie, Groningen.
authors.forename: Tjibbe
authors.initials: T
authors.lastname: Donker
authors.forename: Mariano
authors.initials: M
authors.lastname: Ciccolini
authors.forename: Jacco
authors.initials: J
authors.lastname: Wallinga
authors.forename: Jan A J W
authors.initials: JA
authors.lastname: Kluytmans
authors.forename: Hajo
authors.initials: H
authors.lastname: Grundmann
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Friedrich
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D006761:Hospitals / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D015995:Prevalence
chemical_list: D000900:Anti-Bacterial Agents