A Markov chain model to investigate the spread of antibiotic-resistant bacteria in hospitals

Ordinary differential equation models used in mathematical epidemiology assume explicitly or implicitly large populations. For the study of infections in a hospital, this is an extremely restrictive assumption as typically a hospital ward has a few dozen, or even fewer, patients. This work reframes a well-known model used in the study of the spread of antibiotic-resistant bacteria in hospitals, to consider the pathogen transmission dynamics in small populations. In this vein, this paper proposes a Markov chain model to describe the spread of a single bacterial species in a hospital ward where patients may be free of bacteria or may carry bacterial strains that are either sensitive or resistant to antimicrobial agents. We determine the probability law of the exact reproduction number Rexact,0${\cal R}_{exact,0}$, which is here defined as the random number of secondary infections generated by those patients who are accommodated in a predetermined bed before a patient who is free of bacteria is accommodated in this bed for the first time. Specifically, we decompose the exact reproduction number Rexact,0${\cal R}_{exact,0}$ into two contributions allowing us to distinguish between infections due to the sensitive and the resistant bacterial strains. Our methodology is mainly based on structured Markov chains and the use of related matrix-analytic methods. This guarantees the compatibility of the new, finite-population model, with large population models present in the literature and takes full advantage, in its mathematical analysis, of the intrinsic stochasticity.