Extending outbreak investigation with machine learning and graph theory: Benefits of new tools with application to a nosocomial outbreak of a multidrug-resistant organism. (16th February 2023)

• Record Type: Journal Article
• Authors: Atkinson, Andrew; Ellenberger, Benjamin; Piezzi, Vanja; Kaspar, Tanja; Salazar-Vizcaya, Luisa; Endrich, Olga; Leichtle, Alexander B.; Marschall, Jonas
• Is Part Of: Infection control and hospital epidemiology. Volume 44:Number 2(2023)
• Page Start: 246
• Page End: 252
• Publication Date: 2023-02-16
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2022.66
• Languages: English
• ISSNs: 0899-823X

Abstract

Abstract: Objective: From January 1, 2018, until July 31, 2020, our hospital network experienced an outbreak of vancomycin-resistant enterococci (VRE). The goal of our study was to improve existing processes by applying machine-learning and graph-theoretical methods to a nosocomial outbreak investigation. Methods: We assembled medical records generated during the first 2 years of the outbreak period (January 2018 through December 2019). We identified risk factors for VRE colonization using standard statistical methods, and we extended these with a decision-tree machine-learning approach. We then elicited possible transmission pathways by detecting commonalities between VRE cases using a graph theoretical network analysis approach. Results: We compared 560 VRE patients to 86, 684 controls. Logistic models revealed predictors of VRE colonization as age (aOR, 1.4 (per 10 years), with 95% confidence interval [CI], 1.3–1.5; P < .001), ICU admission during stay (aOR, 1.5; 95% CI, 1.2–1.9; P < .001), Charlson comorbidity score (aOR, 1.1; 95% CI, 1.1–1.2; P < .001), the number of different prescribed antibiotics (aOR, 1.6; 95% CI, 1.5–1.7; P < .001), and the number of rooms the patient stayed in during their hospitalization(s) (aOR, 1.1; 95% CI, 1.1–1.2; P < .001). The decision-tree machine-learning method confirmed these findings. Graph network analysis established 3 main pathways by which the VRE cases were connected: healthcare personnel, medical devices, and patient rooms. Conclusions: We identified risk factors for being a VRE carrier, along with 3 important links with VRE (healthcare personnel, medical devices, patient rooms). Data science is likely to provide a better understanding of outbreaks, but interpretations require data maturity, and potential confounding factors must be considered.