A hierarchical spatial modelling approach to investigate MRSA transmission in a tertiary hospital

Kong, Fiona, Paterson, David L., Whitby, Michael, Coory, Michael and Clements, Archie C. A. (2013) A hierarchical spatial modelling approach to investigate MRSA transmission in a tertiary hospital. BMC Infectious Diseases, 13 1: 449.1-449.7. doi:10.1186/1471-2334-13-449


Author Kong, Fiona
Paterson, David L.
Whitby, Michael
Coory, Michael
Clements, Archie C. A.
Title A hierarchical spatial modelling approach to investigate MRSA transmission in a tertiary hospital
Journal name BMC Infectious Diseases   Check publisher's open access policy
ISSN 1471-2334
Publication date 2013-09-30
Sub-type Article (original research)
DOI 10.1186/1471-2334-13-449
Open Access Status DOI
Volume 13
Issue 1
Start page 449.1
End page 449.7
Total pages 7
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2014
Language eng
Subject 2725 Infectious Diseases
Formatted abstract
Background: Most hospitals have a hierarchical design with beds positioned within cubicles and cubicles positioned within wards. Transmission of MRSA may be facilitated by patient proximity and thus the spatial arrangements of beds, cubicles and wards could be important in understanding MRSA transmission risk. Identifying high-risk areas of transmission may be useful in the design of more effective, targeted MRSA interventions.

Methods: Retrospective data on numbers of multi-resistant and non-multiresistant MRSA acquisitions were collected for 52 weeks in 2007 in a tertiary hospital in Brisbane, Australia. A hierarchical Bayesian spatio-temporal modelling approach was used to investigate spatial correlation in the hierarchically arranged datasets. The spatial component of the model decomposes cubicle-level variation into a spatially structured component and a spatially unstructured component, thereby encapsulating the influence of unmeasured predictor variables that themselves are spatially clustered and/or random. A fixed effect for the presence of another patient with the same type of MRSA in the cubicles two weeks prior was included.

Results: The best-fitting model for non-multiresistant MRSA had an unstructured random effect but no spatially structured random effect. The best-fitting model for multiresistant MRSA incorporated both spatially structured and unstructured random effects. While between-cubicle variability in risk of MRSA acquisition within the hospital was significant, there was only weak evidence to suggest that MRSA is spatially clustered. Presence of another patient with the same type of MRSA in the cubicles two weeks prior was a significant predictor of both types of MRSA in all models.

Conclusions: We found weak evidence of clustering of MRSA acquisition within the hospital. The presence of an infected patient in the same cubicle two weeks prior may support the importance of environmental contamination as a source of MRSA transmission. 
Keyword MRSA
Spatial clustering
Spatial model
Staphylococcus aureus
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

 
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