{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T21:39:05Z","timestamp":1769722745957,"version":"3.49.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T00:00:00Z","timestamp":1612310400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ploscompbiol.org"],"crossmark-restriction":false},"short-container-title":["PLoS Comput Biol"],"abstract":"<jats:p>The aim of this study is to analyze patient movement patterns between hospital departments to derive the underlying intra-hospital movement network, and to assess if movement patterns differ between patients at high or low risk of colonization. For that purpose, we analyzed patient electronic medical record data from five hospitals to extract information on risk stratification and patient intra-hospital movements. Movement patterns were visualized as networks, and network centrality measures were calculated. Next, using an agent-based model where agents represent patients and intra-hospital patient movements were explicitly modeled, we simulated the spread of multidrug resistant enterobacteriacae (MDR-E) inside a hospital. Risk stratification of patients according to certain ICD-10 codes revealed that length of stay, patient age, and mean number of movements per admission were higher in the high-risk groups. Movement networks in all hospitals displayed a high variability among departments concerning their network centrality and connectedness with a few highly connected departments and many weakly connected peripheral departments. Simulating the spread of a pathogen in one hospital network showed positive correlation between department prevalence and network centrality measures. This study highlights the importance of intra-hospital patient movements and their possible impact on pathogen spread. Targeting interventions to departments of higher (weighted) degree may help to control the spread of MDR-E. Moreover, when the colonization status of patients coming from different departments is unknown, a ranking system based on department centralities may be used to design more effective interventions that mitigate pathogen spread.<\/jats:p>","DOI":"10.1371\/journal.pcbi.1008600","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T18:50:44Z","timestamp":1612378244000},"page":"e1008600","update-policy":"https:\/\/doi.org\/10.1371\/journal.pcbi.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Relevance of intra-hospital patient movements for the spread of healthcare-associated infections within hospitals - a mathematical modeling study"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3047-9174","authenticated-orcid":true,"given":"Hannan","family":"Tahir","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9347-527X","authenticated-orcid":true,"given":"Luis Eduardo","family":"L\u00f3pez-Cort\u00e9s","sequence":"additional","affiliation":[]},{"given":"Axel","family":"Kola","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3181-9791","authenticated-orcid":true,"given":"Dafna","family":"Yahav","sequence":"additional","affiliation":[]},{"given":"Andr\u00e9","family":"Karch","sequence":"additional","affiliation":[]},{"given":"Hanjue","family":"Xia","sequence":"additional","affiliation":[]},{"given":"Johannes","family":"Horn","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1511-074X","authenticated-orcid":true,"given":"Konrad","family":"Sakowski","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0156-8290","authenticated-orcid":true,"given":"Monika J.","family":"Piotrowska","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9907-344X","authenticated-orcid":true,"given":"Leonard","family":"Leibovici","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1271-7204","authenticated-orcid":true,"given":"Rafael T.","family":"Mikolajczyk","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4394-7697","authenticated-orcid":true,"given":"Mirjam E.","family":"Kretzschmar","sequence":"additional","affiliation":[]}],"member":"340","published-online":{"date-parts":[[2021,2,3]]},"reference":[{"issue":"3","key":"pcbi.1008600.ref001","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S1473-3099(08)70041-0","article-title":"Extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae: an emerging public-health concern","volume":"8","author":"JD Pitout","year":"2008","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"pcbi.1008600.ref002","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.idc.2016.02.004","article-title":"Multidrug-resistant bacteria in the community: trends and lessons learned","volume":"30","author":"D Van Duin","year":"2016","journal-title":"Infect Dis Clin"},{"key":"pcbi.1008600.ref003","first-page":"1","article-title":"Antimicrobial resistance: tackling a crisis for the health and wealth of nations","volume":"20","author":"J O\u2019neill","year":"2014","journal-title":"Rev Antimicrob Resist"},{"key":"pcbi.1008600.ref004","article-title":"European centre for disease prevention and control","author":"C Suetens","year":"2013","journal-title":"Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals Sweden: ECDC"},{"issue":"1","key":"pcbi.1008600.ref005","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/S1473-3099(18)30605-4","article-title":"Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis","volume":"19","author":"A Cassini","year":"2019","journal-title":"Lancet Infect Dis"},{"issue":"10","key":"pcbi.1008600.ref006","doi-asserted-by":"crossref","first-page":"e1002150","DOI":"10.1371\/journal.pmed.1002150","article-title":"Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study","volume":"13","author":"A Cassini","year":"2016","journal-title":"PLoS Med"},{"issue":"4","key":"pcbi.1008600.ref007","doi-asserted-by":"crossref","first-page":"e35002","DOI":"10.1371\/journal.pone.0035002","article-title":"Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer","volume":"7","author":"T Donker","year":"2012","journal-title":"PLoS One"},{"issue":"3","key":"pcbi.1008600.ref008","doi-asserted-by":"crossref","first-page":"e1000715","DOI":"10.1371\/journal.pcbi.1000715","article-title":"Patient referral patterns and the spread of hospital-acquired infections through national health care networks","volume":"6","author":"T Donker","year":"2010","journal-title":"PLoS Comput Biol"},{"issue":"8","key":"pcbi.1008600.ref009","doi-asserted-by":"crossref","first-page":"e1005666","DOI":"10.1371\/journal.pcbi.1005666","article-title":"Spread of hospital-acquired infections: A comparison of healthcare networks","volume":"13","author":"N Nekkab","year":"2017","journal-title":"PLoS Comput Biol"},{"key":"pcbi.1008600.ref010","doi-asserted-by":"crossref","unstructured":"Piotrowska MJ, Sakowski, K., Lonc, A., Tahir, H., Kretzschmar, M.E. Impact of inter-hospital transfers on the prevalence of resistant pathogens in a hospital-community system. Epidemics (accepted for publication). 2020.","DOI":"10.1016\/j.epidem.2020.100408"},{"issue":"6\u20137","key":"pcbi.1008600.ref011","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.ijmm.2013.02.003","article-title":"Infection prevention in a connected world: The case for a regional approach","volume":"303","author":"M Ciccolini","year":"2013","journal-title":"Int J Med Microbiol"},{"key":"pcbi.1008600.ref012","first-page":"05875","article-title":"Modelling pathogen spread in a healthcare network: indirect patient movements","volume":"2001","author":"MJ Piotrowska","year":"2020","journal-title":"Plos Computational Biology (Revision submitted)"},{"issue":"10","key":"pcbi.1008600.ref013","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1086\/522657","article-title":"Patient-to-patient transmission is important in extended-spectrum \u03b2-lactamase\u2013producing Klebsiella pneumoniae acquisition","volume":"45","author":"A Harris","year":"2007","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pcbi.1008600.ref014","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ajic.2006.09.011","article-title":"How important is patient-to-patient transmission in extended-spectrum \u03b2-lactamase Escherichia coli acquisition","volume":"35","author":"AD Harris","year":"2007","journal-title":"Am J Infect Control"},{"issue":"4","key":"pcbi.1008600.ref015","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1093\/cid\/cix825","article-title":"The transmissibility of antibiotic-resistant Enterobacteriaceae in intensive care units","volume":"66","author":"T Gurieva","year":"2018","journal-title":"Clin Infect Dis"},{"key":"pcbi.1008600.ref016","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.3389\/fmicb.2018.01197","article-title":"Transmission dynamics of hyper-endemic multi-drug resistant Klebsiella pneumoniae in a Southeast Asian neonatal unit: a longitudinal study with whole genome sequencing","volume":"9","author":"PW Smit","year":"2018","journal-title":"Front Microbiol"},{"issue":"5","key":"pcbi.1008600.ref017","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1086\/670216","article-title":"Risk of acquiring extended-spectrum \u03b2-lactamase\u2013producing Klebsiella species and Escherichia coli from prior room occupants in the intensive care unit","volume":"34","author":"AO Ajao","year":"2013","journal-title":"Infection Control & Hospital Epidemiology"},{"issue":"1","key":"pcbi.1008600.ref018","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jhin.2013.03.011","article-title":"Targeted versus universal screening and decolonization to reduce healthcare-associated meticillin-resistant Staphylococcus aureus infection","volume":"85","author":"S Deeny","year":"2013","journal-title":"J Hosp Infect"},{"issue":"12","key":"pcbi.1008600.ref019","doi-asserted-by":"crossref","first-page":"e83099","DOI":"10.1371\/journal.pone.0083099","article-title":"Effectiveness of hospital-wide methicillin-resistant Staphylococcus aureus (MRSA) infection control policies differs by ward specialty","volume":"8","author":"R Sadsad","year":"2013","journal-title":"PLoS One"},{"key":"pcbi.1008600.ref020","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.epidem.2018.11.001","article-title":"The role of intra and inter-hospital patient transfer in the dissemination of heathcare-associated multidrug-resistant pathogens","volume":"26","author":"T Vilches","year":"2019","journal-title":"Epidemics"},{"issue":"2","key":"pcbi.1008600.ref021","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jhin.2006.05.010","article-title":"Epidemiology of infections caused by extended-spectrum \u03b2-lactamase-producing Escherichia coli and Klebsiella spp.: a nested case\u2013control study from a tertiary hospital in London","volume":"64","author":"I Skippen","year":"2006","journal-title":"J Hosp Infect"},{"issue":"3","key":"pcbi.1008600.ref022","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1093\/clinids\/22.3.430","article-title":"Outbreak of multiply resistant Enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition","volume":"22","author":"J-C Lucet","year":"1996","journal-title":"Clin Infect Dis"},{"issue":"8","key":"pcbi.1008600.ref023","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.3201\/eid1308.070071","article-title":"Risk factors for colonization with extended-spectrum \u03b2-lactamase\u2013producing bacteria and intensive care unit admission","volume":"13","author":"AD Harris","year":"2007","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"pcbi.1008600.ref024","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1086\/313590","article-title":"Outbreak of a multiresistant Klebsiella pneumoniae strain in an intensive care unit: antibiotic use as risk factor for colonization and infection","volume":"30","author":"A Asensio","year":"2000","journal-title":"Clin Infect Dis"},{"issue":"11","key":"pcbi.1008600.ref025","doi-asserted-by":"crossref","first-page":"834","DOI":"10.7326\/0003-4819-136-11-200206040-00013","article-title":"The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida","volume":"136","author":"N Safdar","year":"2002","journal-title":"Ann Intern Med"},{"issue":"5","key":"pcbi.1008600.ref026","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.jiac.2013.11.007","article-title":"Risk factors for carbapenem-resistant Klebsiella pneumoniae infection\/colonization: A case\u2013case-control study","volume":"20","author":"DP Kofteridis","year":"2014","journal-title":"J Infect Chemother"},{"key":"pcbi.1008600.ref027","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3389\/fcimb.2018.00004","article-title":"Colonization, infection, and the accessory genome of Klebsiella pneumoniae","volume":"8","author":"RM Martin","year":"2018","journal-title":"Front Cell Infect Microbiol"},{"issue":"1","key":"pcbi.1008600.ref028","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1186\/s12879-017-2754-5","article-title":"Risk factors for multidrug-resistant pathogens in bronchiectasis exacerbations","volume":"17","author":"R Men\u00e9ndez","year":"2017","journal-title":"BMC Infect Dis"},{"issue":"3","key":"pcbi.1008600.ref029","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1128\/MMBR.00078-15","article-title":"Klebsiella pneumoniae: going on the offense with a strong defense","volume":"80","author":"MK Paczosa","year":"2016","journal-title":"Microbiol Mol Biol Rev"},{"issue":"5","key":"pcbi.1008600.ref030","first-page":"532","article-title":"Characteristics of Klebsiella pneumoniae bacteremia in community-acquired and nosocomial infections in diabetic patients","volume":"33","author":"S-S Tsai","year":"2010","journal-title":"Chang Gung Med J"},{"issue":"1","key":"pcbi.1008600.ref031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/1040841X.2013.875515","article-title":"Colonization and infection with extended spectrum beta-lactamase producing Enterobacteriaceae in high-risk patients\u2013Review of the literature from a clinical perspective","volume":"42","author":"LM Biehl","year":"2016","journal-title":"Crit Rev Microbiol"},{"key":"pcbi.1008600.ref032","article-title":"Clinical prediction models for ESBL-Enterobacteriaceae colonization or infection: a systematic review","author":"SMS Lim","year":"2019","journal-title":"J Hosp Infect"},{"key":"pcbi.1008600.ref033","doi-asserted-by":"crossref","unstructured":"McKinney W, editor Data structures for statistical computing in python. Proceedings of the 9th Python in Science Conference; 2010: Austin, TX.","DOI":"10.25080\/Majora-92bf1922-00a"},{"key":"pcbi.1008600.ref034","doi-asserted-by":"crossref","unstructured":"Bastian M., Heymann S., Jacomy M. Eds. Gephi: an open source software for exploring and manipulating networks. Third international AAAI conference on weblogs and social. Media. 2009.","DOI":"10.1609\/icwsm.v3i1.13937"},{"key":"pcbi.1008600.ref035","doi-asserted-by":"crossref","unstructured":"Masad D, Kazil J, editors. MESA: an agent-based modeling framework. 14th PYTHON in Science Conference; 2015.","DOI":"10.25080\/Majora-7b98e3ed-009"},{"key":"pcbi.1008600.ref036","unstructured":"HUVM. Patient movement preference matrix, https:\/\/www.dropbox.com\/s\/l9edlqwus2g0hmm\/HUVM_preference_matrix.csv?dl=0."},{"issue":"1","key":"pcbi.1008600.ref037","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-020-66270-9","article-title":"Dynamic contact networks of patients and MRSA spread in hospitals","volume":"10","author":"LE Rocha","year":"2020","journal-title":"Sci Rep"},{"key":"pcbi.1008600.ref038","doi-asserted-by":"crossref","first-page":"e40977","DOI":"10.7554\/eLife.40977","article-title":"Inference and control of the nosocomial transmission of methicillin-resistant Staphylococcus aureus","volume":"7","author":"S Pei","year":"2018","journal-title":"elife"},{"issue":"5","key":"pcbi.1008600.ref039","doi-asserted-by":"crossref","first-page":"e1006496","DOI":"10.1371\/journal.pcbi.1006496","article-title":"Close proximity interactions support transmission of ESBL-K. pneumoniae but not ESBL-E. coli in healthcare settings","volume":"15","author":"A Duval","year":"2019","journal-title":"PLoS Comput Biol"},{"issue":"9","key":"pcbi.1008600.ref040","doi-asserted-by":"crossref","first-page":"e73970","DOI":"10.1371\/journal.pone.0073970","article-title":"Estimating potential infection transmission routes in hospital wards using wearable proximity sensors","volume":"8","author":"P Vanhems","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"pcbi.1008600.ref041","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/1469-0691.12472","article-title":"Measuring contact patterns with wearable sensors: methods, data characteristics and applications to data-driven simulations of infectious diseases","volume":"20","author":"A Barrat","year":"2014","journal-title":"Clin Microbiol Infect"}],"container-title":["PLOS Computational Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pcbi.1008600","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T16:21:38Z","timestamp":1671034898000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pcbi.1008600"}},"subtitle":[],"editor":[{"given":"Roger Dimitri","family":"Kouyos","sequence":"first","affiliation":[]}],"short-title":[],"issued":{"date-parts":[[2021,2,3]]},"references-count":41,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pcbi.1008600","relation":{},"ISSN":["1553-7358"],"issn-type":[{"value":"1553-7358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,3]]}}}