Epidemiology of MDRO Carriage in Nursing Homes

疗养院内 MDRO 运输的流行病学

• 批准号: 10549490
• 负责人: Susan S. Huang
• 金额: $ 132.71万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-11 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10549490
• 关键词: Affect; Antibiotic Resistance; California; Candida auris; Caring; Communities; Containment; County; Data; Detection; Disease; Environmental Pollution; Epidemiology; Ethnic Origin; Extended-spectrum β-lactamase; Foundations; Goals; Guidelines; Health; Hospitalization; Hospitals; Human; Individual; Infection; Infection prevention; Intervention; Investments; Knowledge; Length of Stay; Measures; Methods; Morbidity - disease rate; Nursing Homes; Oranges; Outcome; Persons; Policies; Population; Prevalence; Prevention; Prospective Studies; Public Health; Race; Resources; Retrospective Studies; Risk Assessment; Risk Factors; Sampling; Site; Socioeconomic Status; Training; Vancomycin resistant enterococcus; Vancomycin-resistant S. aureus; Vulnerable Populations; carbapenem resistance; care delivery; clinically significant; combat; contagion; economic disparity; effective intervention; ethnic disparity; fungus; health care disparity; health care settings; medical vulnerability; methicillin resistant Staphylococcus aureus; mortality; multi-drug resistant pathogen; pathogen; prevent; prospective; racial disparity; screening; transmission process; trend

Abstract Project 1: Epidemiology of MDRO Carriage and Adverse Health Outcomes in Nursing Homes Multidrug-resistant organisms (MDROs) are serious and urgent threats to human health. Although extensive efforts have begun to reverse the tide in hospitals, investments are severely lacking in nursing homes (NHs) where MDRO prevalence is much greater (routinely 65% vs. 10% in hospitals). NHs are unique settings that may be particularly prone to spreading contagion due to their long lengths-of-stay, care of medically vulnerable residents, encouragement of shared spaces and activities, high staff turnover, and limited infection prevention training. Due to scarce resources for screening, surveillance, and strategies to combat MDROs, evidence is needed to create guidelines for MDRO reduction strategies specific to NHs. This project will encompass an in-depth and simultaneous assessment of five major MDROs of clinical significance to the 1.4 million people who are cared for in 15,000 U.S. nursing homes each year. These MDROs include three endemic pathogens that are entrenched in NHs, namely methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and extended-spectrum beta- lactamase producers (ESBLs), as well as two emerging MDROs– carbapenem-resistant Enterobacterales (CRE), and Candida auris, an antibiotic-resistant fungus capable of substantial morbidity and mortality. The goal of the simultaneous assessment of these MDROs is to assess synergistic capture from screening cultures and inform interventions that would target MDROs in concert. We will capitalize on the combination of retrospective and prospective studies involving over 10,000 NH residents from 50 NHs to evaluate efficient ways to sample body sites and environmental objects for MDRO carriage and co-carriage. We also will perform comprehensive assessments of resident, NH, and community- level risk factors for carriage of MDROs, alone and in combination. Beyond carriage, we will use these data to assess risk factors for later MDRO infection and hospitalization. Importantly, we will specifically evaluate whether risk factors are differentially affected by race, ethnicity, and socioeconomic status to better elucidate NH disparities in care delivery or health outcomes. Knowledge of major drivers of carriage and infection will inform the need and value of NH interventions to transform policy and practice.

抽象的 项目1：疗养院中MDRO运输和不良健康结果的流行病学 耐多药的生物（MDRO）对人类健康是严重且紧急的威胁。虽然 广泛的努力已经开始扭转医院的潮流，护士严重缺乏投资 MDRO患病率要大得多（通常为65％和医院的10％）的房屋（NHS）。 NHS是独一无二的 由于较长的住宿时间，可能特别容易传播传染的设置， 医学上脆弱的居民，共享空间和活动的鼓励，员工流动人数高以及有限 感染预防培训。由于资源稀缺，用于筛查，监视和战斗的策略 MDRO，需要证据来为NHS特定的MDRO减少策略创建准则。 该项目将涵盖对五个临床的五个主要MDRO的深入和简单评估 对于每年15,000名美国护士住宅中受到照顾的140万人的意义。这些 MDROS包括三种内在病原体，这些病原体在NHS中固定在NHS中，即耐甲氧西林 金黄色葡萄球菌（MRSA），万古霉素的肠球菌（VRE）和延伸的光谱β- 乳糖酶生产者（ESBL），以及两个新兴的MDROS-抗碳青霉烯的肠杆菌 （CRE）和念珠菌（Candida Auris），一种抗生素的真菌，能够具有很大的发病率和死亡率。 对这些MDRO进行简单评估的目标是评估筛查培养物中的协同捕获 并告知将针对MDROS的干预措施。 我们将利用涉及10,000多个NH的回顾性研究和前瞻性研究的结合 来自50 NHS的居民评估MDRO的身体部位和环境对象采样的有效方法 马车和共同货车。我们还将对NH和社区居民进行全面评估 - 单独和组合MDRO的运输水平风险因素。除了马车之外，我们将使用这些数据 评估以后MDRO感染和住院的危险因素。重要的是，我们将专门评估 风险因素是否会受到种族，种族和社会经济地位的不同影响，以更好地阐明 NH护理分娩或健康成果的差异。了解马车和感染的主要驱动因素 告知NH干预措施的需求和价值，以改变政策和实践。