Mathematical Modeling of the Transmission Dynamics of Clostridium difficile Infection and Colonization in Healthcare Settings: A Systematic Review.
BACKGROUND
We conducted a systematic review of mathematical models of transmission dynamic of Clostridium difficile infection (CDI) in healthcare settings, to provide an overview of existing models and their assessment of different CDI control strategies.


METHODS
We searched MEDLINE, EMBASE and Web of Science up to February 3, 2016 for transmission-dynamic models of Clostridium difficile in healthcare settings. The models were compared based on their natural history representation of Clostridium difficile, which could include health states (S-E-A-I-R-D: Susceptible-Exposed-Asymptomatic-Infectious-Resistant-Deceased) and the possibility to include healthcare workers and visitors (vectors of transmission). Effectiveness of interventions was compared using the relative reduction (compared to no intervention or current practice) in outcomes such as incidence of colonization, CDI, CDI recurrence, CDI mortality, and length of stay.


RESULTS
Nine studies describing six different models met the inclusion criteria. Over time, the models have generally increased in complexity in terms of natural history and transmission dynamics and number/complexity of interventions/bundles of interventions examined. The models were categorized into four groups with respect to their natural history representation: S-A-I-R, S-E-A-I, S-A-I, and S-E-A-I-R-D. Seven studies examined the impact of CDI control strategies. Interventions aimed at controlling the transmission, lowering CDI vulnerability and reducing the risk of recurrence/mortality were predicted to reduce CDI incidence by 3-49%, 5-43% and 5-29%, respectively. Bundles of interventions were predicted to reduce CDI incidence by 14-84%.


CONCLUSIONS
Although CDI is a major public health problem, there are very few published transmission-dynamic models of Clostridium difficile. Published models vary substantially in the interventions examined, the outcome measures used and the representation of the natural history of Clostridium difficile, which make it difficult to synthesize results and provide a clear picture of optimal intervention strategies. Future modeling efforts should pay specific attention to calibration, structural uncertainties, and transparent reporting practices.
SP-POS, Centre de recherche du CHU de Québec-Université Laval, 1050 Chemin Sainte-Foy, Québec, Qc, Canada.|Départment de Médecine Sociale et Préventive, Université Laval, Québec, Qc, Canada.
Guillaume
G
Gingras
SP-POS, Centre de recherche du CHU de Québec-Université Laval, 1050 Chemin Sainte-Foy, Québec, Qc, Canada.|Départment de Médecine Sociale et Préventive, Université Laval, Québec, Qc, Canada.
Marie-Hélène
MH
Guertin
SP-POS, Centre de recherche du CHU de Québec-Université Laval, 1050 Chemin Sainte-Foy, Québec, Qc, Canada.
Jean-François
JF
Laprise
SP-POS, Centre de recherche du CHU de Québec-Université Laval, 1050 Chemin Sainte-Foy, Québec, Qc, Canada.
Mélanie
M
Drolet
SP-POS, Centre de recherche du CHU de Québec-Université Laval, 1050 Chemin Sainte-Foy, Québec, Qc, Canada.|Départment de Médecine Sociale et Préventive, Université Laval, Québec, Qc, Canada.|Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom.
Marc
M
Brisson
Med Decis Making. 2012 Sep-Oct;32(5):733-43
22990088
BMC Public Health. 2010 Nov 18;10:710
21087466
Value Health. 2012 Sep-Oct;15(6):835-42
22999133
J Infect Dis. 1992 Sep;166(3):561-7
1323621
Infect Control Hosp Epidemiol. 2003 Sep;24(9):699-706
14510254
Lancet Infect Dis. 2008 Mar;8(3):200-7
18291341
J Hosp Infect. 2009 Jan;71(1):49-56
19013677
Value Health. 2013 Mar-Apr;16(2):231-50
23538175
J Hosp Infect. 2014 May;87(1):25-33
24746230
Am J Infect Control. 2013 Jun;41(6):537-41
23219675
Reprod Health Matters. 2003 Nov;11(22):74-90
14708399
Science. 2015 Mar 13;347(6227):aaa4339
25766240
Conn Med. 2013 Feb;77(2):69-75
23513633
J Hosp Infect. 2015 Jun;90(2):91-101
25913648
Infect Control Hosp Epidemiol. 2014 Jan;35(1):10-5
24334792
Vaccine. 1999 Oct 29;17 Suppl 3:S53-5
10559535
Clin Infect Dis. 2014 May;58(10):1394-400
24604900
Value Health. 2012 Sep-Oct;15(6):828-34
22999132
Clin Infect Dis. 2010 Jan 15;50(2):194-201
20025526
Am J Infect Control. 2009 Aug;37(6):458-64
19243859
N Engl J Med. 2011 Nov 3;365(18):1693-703
22047560
Value Health. 2015 Jun;18(4):512-29
26091606
Pharmacoeconomics. 2006;24(4):355-71
16605282
Cochrane Database Syst Rev. 2013 Apr 30;(4):CD003543
23633313
BMC Infect Dis. 2013 Jun 28;13:294
23809195
Med Decis Making. 2015 Feb;35(2):211-29
25112595
Clin Infect Dis. 2013 Oct;57(8):1094-102
23881150
Clin Infect Dis. 2007 Nov 15;45(10):1266-73
17968819
Int J Infect Dis. 2012 Nov;16(11):e768-73
22921930
Health Technol Assess. 2004 Sep;8(36):iii-iv, ix-xi, 1-158
15361314
BMJ. 2009 Jul 21;339:b2700
19622552
J Hosp Infect. 2013 Jul;84(3):227-34
23787167
PLoS One. 2013 Nov 21;8(11):e80671
24278304
Vaccine. 2015 Jun 19;33 Suppl 3:C42-54
25921288
JAMA Intern Med. 2016 Jun 1;176(6):796-804
27111806
Clin Infect Dis. 2000 Oct;31(4):995-1000
11049782
N Engl J Med. 2013 Sep 26;369(13):1195-205
24066741
Value Health. 2012 Sep-Oct;15(6):804-11
22999129
Int J Infect Dis. 2014 May;22:9-10
24583565
Value Health. 2001 Sep-Oct;4(5):348-61
11705125
Emerg Microbes Infect. 2014 Jun;3(6):e43
26038744
Int J Antimicrob Agents. 2013 Feb;41(2):137-42
23276500
Clin Infect Dis. 2007 Sep 1;45 Suppl 2:S112-21
17683015
Am J Infect Control. 2012 Sep;40(7):663-6
22153847
J Antimicrob Chemother. 2007 May;59(5):990-5
17387117
Infect Control Hosp Epidemiol. 2011 Nov;32(11):1137-9
22011546
Am J Med. 1991 Sep 16;91(3B):138S-144S
1928155
BMC Infect Dis. 2013 Aug 16;13:376
23947736
Infect Control Hosp Epidemiol. 2008 Aug;29(8):723-9
18636950
Infect Control Hosp Epidemiol. 2014 Aug;35(8):1043-50
25026622
Virulence. 2016;7(2):163-73
26399855
Antimicrob Agents Chemother. 2014 Sep;58(9):5079-83
24936597
Clin Microbiol Infect. 2010 Aug;16(8):1297-302
19832710
J Hosp Infect. 2010 Apr;74(4):309-18
20153547
Open Forum Infect Dis. 2015 Jun 03;2(3):ofv076
26191534
Am J Gastroenterol. 2015 Mar;110(3):381-90; quiz 391
25732416
Clin Microbiol Infect. 2001 Aug;7(8):432-7
11591207
Value Health. 2012 Sep-Oct;15(6):796-803
22999128
Clin Infect Dis. 2008 Nov 1;47(9):1162-70
18808358
Value Health. 2014 Mar;17(2):174-82
24636375
Clin Infect Dis. 2015 Jul 15;61(2):233-41
25828993
Am J Infect Control. 2010 Jun;38(5):350-3
20123150
Infect Control Hosp Epidemiol. 2016 Apr;37(4):433-9
26752662
Infect Control Hosp Epidemiol. 2014 Jan;35(1):18-27
24334794
Infect Control Hosp Epidemiol. 2011 Mar;32(3):207-9
21460504
Value Health. 2003 Jan-Feb;6(1):9-17
12535234
Am J Med. 1981 Apr;70(4):906-8
7211925
J Antimicrob Chemother. 2011 Sep;66(9):2168-74
21676904
J Hosp Infect. 2015 Sep;91(1):74-80
26169793
Lancet. 2005 Sep 24-30;366(9491):1079-84
16182895
Pharmacoeconomics. 2011 May;29(5):371-86
21504239
Infect Control Hosp Epidemiol. 2011 Jun;32(6):553-61
21558767
Infect Control Hosp Epidemiol. 2009 Feb;30(2):156-62
19125681