Abstract
ABSTRACTA deterministic mathematical model with periodic antibiotic prescribing rate is constructed to study the seasonality of Methicillin-resistant Staphylococcus aureus (MRSA) infections taking antibiotic exposure and environmental contamination into consideration. The basic reproduction number for the periodic model is calculated under the assumption that there are only uncolonized patients with antibiotic exposure at admission. Sensitivity analysis of with respect to some essential parameters is performed. It is shown that the infection would go to extinction if the basic reproduction number is less than unity and would persist if it is greater than unity. Numerical simulations indicate that environmental cleaning is the most important intervention to control the infection, which emphasizes the effect of environmental contamination in MRSA infections. It is also important to highlight the importance of effective antimicrobial stewardship programmes, increase active screening at admission and subsequent isolation of positive cases, and treat patients quickly and efficiently.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA), a type of staph bacteria first discovered in 1961, is one of the most common causes of hospital-acquired infections
Based on the seasonal pattern of antibiotic usage observed in Sun et al [22], we assume that antibiotic prescription rate in hospital increases starting at the beginning of August, gains a peak in winter and decreases starting at the beginning of February according to the data shown in Figures 1 and 2, which results in the similar pattern of colonized patients with antibiotic exposure in Figures 4 and 5(a), but with a lag about 15-days
Since we assume that the free-living bacteria have no proper condition to reproduce themselves, shedding bacteria from colonized patients is a crucial factor in environmental contamination, which is verified in Figure 8(b) where if the shedding rate of colonized patients with antibiotic exposure υpA is below 300, the basic reproduction number can be below 1
Summary
Methicillin-resistant Staphylococcus aureus (MRSA), a type of staph bacteria first discovered in 1961, is one of the most common causes of hospital-acquired infections. In recent decades seasonal variation of MRSA infections in the hospital settings has been widely observed, especially in surgical wound, skin and soft tissue, urine, and respiratory tract in young children [12,14,17,18,21,22]. Similar results were found for both the percentage of MRSA isolates resistant to clindamycin and macrolide/lincosamide prescriptions (see Figure 2). Though this does not totally reflect the antibiotic usage in hospitals, [21,22] indicate that the usage of antibiotics in hospitals should fluctuate seasonally. Simulations and discussion of the model behaviours and sensitive analysis of the basic reproduction number are given in the last two sections
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