Institute for Infection Prevention and Control

National health infrastructures, utilization of health services, and patient movements between hospitals

There is global concern about the emergence and increasing spread of so-called "high-risk" clones of antibiotic-resistant bacteria. These usually carry genetic determinants for multiple resistance and are particularly easily transmissible in hospitals. Regional, national, and international surveillance is considered an important part of a strategy to contain their further spread. However, current surveillance systems are not suitable for this purpose, and there is still a lack of solid evidence to decide which and how many sentinel sites (e.g., hospitals) should be included in surveillance programs. Previous studies have shown that antibiotic-resistant "high-risk" clones spread through patient movements between healthcare facilities. In this way, connections are created between hospitals through patient transfers. Taken together, these connections form a network of facilities that can be described as a national healthcare referral network. Despite their apparent complexity, these networks exhibit a simple underlying structure and remarkably consistent properties that lie at the heart of national health infrastructures. They display typical characteristics of so-called hierarchically distributed networks, including regionality, centrality, scale freedom, and "small world" properties. A quantitative understanding of network dynamics therefore offers the opportunity to design targeted surveillance strategies and align interventions more effectively. The current network initiative, supported by JPIAMR and the German Federal Ministry of Education and Research (BMBF), brings together a critical mass of experts in the fields of public health microbiology, health research, and social network analysis from Europe and beyond. The aim of this collaboration is to define the necessary data requirements, data sources, algorithms, and analysis tools in order to develop a heuristic optimization approach for the selection of sentinel sites. The project will thus develop recommendations for the development of surveillance structures that are more economical, cost- and time-efficient – and, through the targeted selection of sampling locations, also enable genomic surveillance using whole genome sequencing (WGS). In this way, genetic signatures can be provided for an early, next-generation diagnostic procedure for detecting emerging threats to public health.