Modeling the regional spread and control of vancomycin-resistant enterococci

Bruce Y. Lee, S. Levent Yilmaz, Kim F. Wong, Sarah M. Bartsch, Stephen Eubank, Yeohan Song, Taliser R. Avery, Richard Christie, Shawn T. Brown, Joshua M. Epstein, Jon I. Parker, Susan S. Huang

Research output: Contribution to journalArticlepeer-review


Background: Because patients can remain colonized with vancomycin-resistant enterococci (VRE) for long periods of time, VRE may spread from one health care facility to another. Methods: Using the Regional Healthcare Ecosystem Analyst, an agent-based model of patient flow among all Orange County, California, hospitals and communities, we quantified the degree and speed at which changes in VRE colonization prevalence in a hospital may affect prevalence in other Orange County hospitals. Results: A sustained 10% increase in VRE colonization prevalence in any 1 hospital caused a 2.8% (none to 62%) average relative increase in VRE prevalence in all other hospitals. Effects took from 1.5 to >10 years to fully manifest. Larger hospitals tended to have greater affect on other hospitals. Conclusions: When monitoring and controlling VRE, decision makers may want to account for regional effects. Knowing a hospital's connections with other health care facilities via patient sharing can help determine which hospitals to include in a surveillance or control program.

Original languageEnglish (US)
Pages (from-to)668-673
Number of pages6
JournalAmerican Journal of Infection Control
Issue number8
StatePublished - Aug 2013


  • Health care-associated infections
  • Hospitals
  • Modeling
  • Simulation
  • Vancomycin-resistant Enterococcus

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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