Analyse van patiëntstromen

Antibiotic resistance is a worldwide threat to health care as it impairs the effective treatment of bacterial infections. Measures against the spread of resistance are mainly focused on individual health care institutions as these are viewed as the main source of resistance. However, health care institutions are not completely independent in their control of the prevalence of resistance, as movement of patients between hospitals and care institutions can induce movement of resistant micro-organisms. In other words, antibiotic resistance follows the flow of patients. Mapping this flow of patients results in a network that includes all health care institutions, and has a distinctive modular structure. Patients are moved primarily within regions, much less so between regions. We argue that the structure of this health care network should be used to design efficient and effective control strategies. To this end, we advocate (a) regional coordination of control measures, (b) differentiation of investment in infection prevention according to the network position of the institution, and (c) setting up sentinel surveillance based on the health care network.

Conflict of interest and financial support: the research of prof.dr. Friedrich was financially supported by the European Commission, the German Federal States of Nordrhein-Westfalen and Niedersachsen, and the Dutch provinces of Overijssel, Gelderland and Limburg. ICMJE forms provided by the authors are available online along with the full text of this article.