Effectiveness of Treatment and Outcomes for Veterans Infected with Resistant Gram-negative Organisms.

感染耐药革兰氏阴性菌的退伍军人的治疗效果和结果。

• 批准号: 10186505
• 负责人: CHARLESNIKA T EVANS
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186505
• 关键词: Accounting; Acinetobacter; Acinetobacter baumannii; Amputation; Antibiotic Resistance; Antibiotic Therapy; Antibiotic-resistant organism; Antibiotics; Bacteria; Bacterial Infections; Carbapenems; Caring; Categories; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical; Clinical Practice Guideline; Clostridium difficile; Combined Modality Therapy; Community Hospitals; Comparative Effectiveness Research; Complex; Cost Effectiveness Analysis; Data; Data Sources; Databases; Development; Devices; Direct Costs; Drug resistance; Effectiveness; Electronic Health Record; Enterobacter; Enterobacteriaceae; Escherichia coli; Failure; Goals; Health system; Healthcare; Hospital Mortality; Hospitalization; Hospitals; Infection; Inpatients; Intervention; Klebsiella; Klebsiella pneumoniae; Length of Stay; Medical; Meningitis; Microbiology; Morbidity - disease rate; Multi-Drug Resistance; Nosocomial Infections; Organism; Outcome; Outcome Study; Patient-Focused Outcomes; Patients; Pharmacy facility; Pneumonia; Population; Population Heterogeneity; Prevalence; Pseudomonas aeruginosa; Recommendation; Regimen; Research; Resistance; Risk Factors; Safety; Sepsis; Spinal cord injury; Surgical Wound Infection; Time; Treatment Effectiveness; Treatment Failure; Treatment Protocols; Treatment outcome; Veterans; Work; acute care; adverse outcome; antibiotic resistant infections; antimicrobial; carbapenem resistance; carbapenem-resistant Enterobacteriaceae; care seeking; clinical practice; comparative; comparative effectiveness; comparative effectiveness study; compare effectiveness; complex chronic conditions; cost; effective therapy; experience; health care settings; healthcare-associated infections; improved; infection rate; infection risk; innovation; methicillin resistant Staphylococcus aureus; military veteran; mortality; multi-drug resistant pathogen; multidrug-resistant Pseudomonas aeruginosa; patient population; programs; transmission process; treatment comparison; treatment guidelines; treatment strategy

Approximately 0.7 to 1.7 million health care-associated infections (HAIs) occur in the U.S. each year in inpatients receiving care in U.S. acute care community-hospital stays. Many of these infections are caused by antibiotic resistant organisms including multidrug resistant gram-negative organisms (MDRGNOs). One of the prime predictors of morbidity and mortality following infection with drug resistant organisms is inadequate empiric and definitive antibiotic treatment of the infection. Lack of specific clinical practice guidelines for treatment of these organisms increases the ambiguity of effective treatment strategies. It is unclear what treatment regimens are being used within VA for treatment of MDRGNOs nor how effective they are. Therefore, the goal of this study is to use national VA data to describe current treatment strategies for select MDRGNOs (Carbapenem Resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa, and Acinetobacter species) and the comparative effectiveness of these strategies on outcomes in Veterans. This study is highly relevant to patients seeking care in VA, as Veterans experience many of the risk factors associated with development of an MDRGNO infection. VA treats patients with serious complex conditions that require frequent hospitalization or contact with health care or use of invasive devices (i.e. spinal cord injury, amputations) that put them at risk for infections. MDRGNOS and inadequate treatment have a significant impact on morbidity and mortality outcomes in those with complex conditions. Also, the proposed research is related to the VA's Multidrug Resistant Organism (MDRO) Program that has developed and implemented national programs to reduce the transmission and spread of MRSA and Clostridium difficile. Our findings will produce effectiveness data on outcomes for MDRGNOs including CRE in a diverse population of Veterans that can be used by VA program offices for developing guidance for treatment. This research is innovative in that it will be the first study, to our knowledge, utilizing national VA microbiology, pharmacy, and medical encounter databases to answer comparative effectiveness research questions on effective treatment strategies for MDRGNOs. The long-term goal will be to develop actionable findings for decision makers that can be implemented to improve the effectiveness of treatment and healthcare of patients with MDRGNO infections across different populations.

每年在美国发生约0.7至170万卫生保健相关感染（HAI） 在美国急性护理社区住院中接受护理的住院病人住宿。这些感染中有许多是引起的 通过抗生素耐药的生物，包括耐多药革兰氏阴性生物（MDRGNOS）。一 耐药生物感染后发病和死亡率的主要预测因素是 感染的经验性和确定性抗生素治疗不足。缺乏特定的临床实践 这些生物的治疗指南增加了有效治疗策略的歧义。这是 尚不清楚VA中使用哪种治疗方案用于治疗MDRGNOS或有效性 他们是。因此，这项研究的目的是使用国家VA数据来描述当前的治疗策略 用于精选的MDRGNO（耐碳青霉烯二肠杆菌科（CRE），铜绿假单胞菌和 所有策略对退伍军人的结果的比较有效性。 这项研究与在VA中寻求护理的患者高度相关，因为退伍军人经历了许多风险因素 与MDRGNO感染的发展有关。 VA治疗患者患有严重的复杂条件 这需要经常住院或与医疗保健接触或使用入侵设备（即脊髓 伤害，截肢），使它们有感染的风险。 MDRGNOS和治疗不足的 对患有复杂条件的人的发病率和死亡率的重大影响。另外，提议 研究与开发和 实施了国家计划，以减少MRSA和艰难梭菌的传播和传播。 我们的发现将对包括CRE在内的MDRGNO的结果产生有效性数据 VA计划办公室可以使用的退伍军人人口来制定治疗指南。这 研究具有创新性，据我们所知，它将是使用国家VA微生物学的第一个研究， 药房和医疗遭遇数据库，以回答有关比较有效性研究问题 MDRGNOS的有效治疗策略。长期目标是为了制定可行的发现 可以实施以提高治疗和医疗保健有效性的决策者 不同人群中MDRGNO感染的患者。

项目成果

Uptake in newly approved antibiotics prescribed to patients with carbapenem-resistant Enterobacterales (CRE).

• DOI: 10.1017/ice.2021.452
• 发表时间: 2023-04
• 期刊: INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
• 影响因子: 4.5
• 作者: Suda, Katie J.;Traversa, Alfredo;Patel, Ursula;Poggensee, Linda;Fitzpatrick, Margaret A.;Wilson, Geneva M.;Evans, Charlesnika T.
• 通讯作者: Evans, Charlesnika T.

Evaluating the clinical effectiveness of new beta-lactam/beta-lactamase inhibitor combination antibiotics: A systematic literature review and meta-analysis.

• DOI: 10.1017/ash.2021.217
• 发表时间: 2021
• 期刊: Antimicrobial stewardship & healthcare epidemiology : ASHE
• 作者: Wilson, Geneva M;Fitzpatrick, Margaret A;Walding, Kyle;Gonzalez, Beverly;Schweizer, Marin L;Suda, Katie J;Evans, Charlesnika T
• 通讯作者: Evans, Charlesnika T

Epidemiology and clinical outcomes associated with extensively drug-resistant (XDR) Acinetobacter in US Veterans' Affairs (VA) medical centers.

• DOI: 10.1017/ice.2020.450
• 发表时间: 2021-03
• 期刊: Infection control and hospital epidemiology
• 影响因子: 4.5
• 作者: Fitzpatrick MA;Suda KJ;Poggensee L;Vivo A;Wirth M;Wilson G;Evans M;Evans CT
• 通讯作者: Evans CT

Treatment of extensively-drug resistant (XDR) Acinetobacter and impact on clinical outcomes in U.S. veterans affairs (VA) medical centers.

• DOI: 10.1016/j.ajic.2022.01.011
• 发表时间: 2022-09
• 期刊: American journal of infection control
• 影响因子: 4.9