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A model of Carbapenemase-Producing Enterobacteriaceae spreading in the French hospitals network

Abstract : Background Carbapenemase-Producing Enterobacteriaceae (CPE) are spreading at an alarming rate and threaten health systems and patient safety worldwide. In France, their transmission is driven by importation of international cases and inter-regional dissemination due to patients’ transfers between hospitals. This study aims at defining a mathematical model reproducing CPE transmission on the French network of hospitals. Methods CPE spreading is modeled using a stochastic susceptible-colonized-infected (SCI) hospital-based model. It takes into account both CPE dissemination through patient transfers, and importations either from foreign countries or in-town transmission. The patient transfer network was reconstructed using data from the French hospital discharge database (PMSI) over the years 2014-2017. Epidemiological parameters were estimated from surveillance data of CPE episodes from August 2010 to November 2016 from the French national Healthcare-Associated Infections Early Warning and Response System. Results Our epidemiological model replicates the number of CPE hospital outbreaks occurring in France on a network of 2,433 hospitals. It allows to estimate the number of unobserved hospitals’ colonization and differentiate outbreaks due to foreign importation from outbreaks due to patient transfers. Finally, the model can be used to benchmark control strategies based on patient redirections, or targeted screening. Conclusions This study is the first to simulate CPE spread in France using real-life patient transfers data. Our mathematical model may further help public health authorities in the definition and evaluation of new control strategies of CPE transmission based on patient flows between hospitals.
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Contributor : Laurent Jonchère <>
Submitted on : Friday, February 7, 2020 - 3:12:00 PM
Last modification on : Monday, July 20, 2020 - 11:04:04 AM

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Jonathan Roux, C. Massonnaud, Pascal Crepey. A model of Carbapenemase-Producing Enterobacteriaceae spreading in the French hospitals network. European Journal of Public Health, Oxford University Press (OUP): Policy B - Oxford Open Option D, 2019, 29 (Supplement_4), ⟨10.1093/eurpub/ckz186.531⟩. ⟨hal-02470787⟩



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