Simulating the Spread and Control of Multiple MDROs Across a Network of Different Nursing Homes

模拟多个 MDRO 在不同疗养院网络中的传播和控制

• 批准号: 10549492
• 负责人: Bruce Y Lee
• 金额: $ 52.63万
• 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/10549492
• 关键词: Affect; Area; California; Candida auris; Cause of Death; Characteristics; Circulation; Clinical; Complex; Computer Models; County; Data; Data Analyses; Data Collection; Economics; Ecosystem; Epidemiology; Equipment; Extended-spectrum β-lactamase; Goals; Individual; Infection Control; Integration Host Factors; Intervention; Long-Term Care Nursing; Modeling; Nursing Homes; Nursing Models; Oranges; Outcome; Policies; Prevention; Principal Investigator; Research Personnel; Resources; Testing; Time; Translations; Vancomycin resistant enterococcus; Vancomycin-resistant S. aureus; Work; burden of illness; carbapenem resistance; comorbidity; economic impact; economic value; healthcare-associated infections; infection risk; innovation; insight; methicillin resistant Staphylococcus aureus; multi-drug resistant pathogen; multimodality; pathogen; synergism; transmission process; wound; Affect; Area; California; Candida auris; Cause of Death; Characteristics; Circulation; Clinical; Complex; Computer Models; County; Data; Data Analyses; Data Collection; Economics; Ecosystem; Epidemiology; Equipment; Extended-spectrum β-lactamase; Goals; Individual; Infection Control; Integration Host Factors; Intervention; Long-Term Care Nursing; Modeling; Nursing Homes; Nursing Models; Oranges; Outcome; Policies; Prevention; Principal Investigator; Research Personnel; Resources; Testing; Time; Translations; Vancomycin resistant enterococcus; Vancomycin-resistant S. aureus; Work; burden of illness; carbapenem resistance; comorbidity; economic impact; economic value; healthcare-associated infections; infection risk; innovation; insight; methicillin resistant Staphylococcus aureus; multi-drug resistant pathogen; multimodality; pathogen; synergism; transmission process; wound

Abstract Project 3: Simulating the Spread and Control of Multiple MDROs Across a Network of Nursing Homes in a Region Multidrug-resistant organisms (MDROs) cause nearly 3 million healthcare-associated infections (HAIs), which are a major cause of death in US nursing homes (NHs), annually. While MDROs are commonly studied in isolation, these pathogens circulate simultaneously, and their spread and prevention may affect and compound each other. Therefore, determining the value of such strategies in NHs requires an understanding of how they would affect colonization and infection risks of various MDROs simultaneously. Moreover, the impact of MDROs and their prevention and control strategies extend beyond individual NHs and involve the dynamic ecosystem of NHs in a region. Computational modeling that integrates epidemiologic, operational, and economic components can help delineate the circulation and impact of multiple MDROs, test various prevention and control strategies, and determine the subsequent ecosystem-wide effects related to transmission and disease burden in ways that can save time, effort, and resources. The overall goal of this proposed project is to elucidate (1) the combined effects of multiple MDROs spreading simultaneously and (2) how policies and interventions (e.g., contact precautions, decolonization) may have an impact across a variety of MDROs at the same time, using agent-based models (ABMs) of NHs in Orange County (OC), California (CA). These detailed representations of NHs will include and help differentiate among various multi-level factors affecting MDRO spread. This modeling Project will proceed in a synergistic, iterative manner with the other two Projects. Model results will guide data collection and analyses for Projects 1 and 2, and data insights from Projects 1 and 2 will guide further refinement of the models. Shifting the focus from one MDRO at a time to various MDROs collectively will help decision makers choose the best overall infection control strategy. Specific Aim 1 will develop ABMs for each of the 70 nursing NHs in OC, CA simulating how multiple MDROs (methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales, and Candida auris) interact among carriers and co-carriers to promote spread. Specific Aim 2 will evaluate how different pathogens, host factors (e.g., comorbidities, wounds, bedbound status), and room characteristics (e.g., roommates, common areas, shared equipment) simultaneously affect MDRO transmission in NHs across a region using the various NH ABMs. Specific Aim 3 will estimate how various pathogen-specific and non-specific multi-modal strategies may affect the transmission and spread of different MDROs individually and simultaneously in NHs across a region using the NH ABMs.

抽象的 项目3：模拟多个MDROS的传播和控制 跨越一个地区的疗养院网络 多种耐药的生物（MDROS）引起近300万种医疗相关感染（HAIS），， 这是美国疗养院（NHS）的主要死亡原因。而通常研究MDROS 这些病原体孤立地同时循环，它们的传播和预防可能会影响和 互相复合。因此，确定此类策略在NHS中的价值需要了解 它们将如何同时影响各种MDRO的定植和感染风险。而且，影响 MDRO及其预防和控制策略的范围超出了单个NHS，并涉及动态 NHS的生态系统。集成流行病学，操作和 经济组成部分可以帮助描述多个MDRO的循环和影响，测试各种 预防和控制策略，并确定与 以节省时间，精力和资源的方式传播和疾病负担。总体目标 拟议的项目是阐明（1）同时多个MDROS的综合效应 （2）政策和干预措施（例如接触预防措施，非殖民化）如何产生影响 同时使用橙色的NHS基于代理的模型（ABM），同时跨越各种MDROS 县（OC），加利福尼亚（CA）。 NHS的这些详细表示将包括并帮助区分 在影响MDRO扩展的各种多层次因素中。这个建模项目将以协同作用， 其他两个项目的迭代方式。模型结果将指导项目收集和分析1 和2，以及项目1和2的数据见解将指导模型的进一步改进。转移焦点 从一个MDRO一次到各种MDRO，共同帮助决策者选择最佳 总体感染控制策略。特定的目标1将为OC的70个护理NHS中的每一个开发ABM， CA模拟多个MDRO（耐甲氧西林金黄色葡萄球菌，抗性霉素 肠球菌，扩展的谱β-内酰胺酶产生的肠杆菌，抗碳青霉烯 肠杆菌和念珠菌Auris）在载体和共同载体之间相互作用，以促进传播。具体目标 2将评估不同的病原体，宿主因素（例如，合并症，伤口，床头状态）和房间如何 特征（例如室友，公共区域，共享设备）同时影响MDRO 使用各种NH ABM在NHS中传播NHS。特定目标3将估计各种 病原体特异性和非特异性多模式策略可能会影响不同的传播和传播 使用NH ABMS单独和同时在NHS中单独和同时使用NH。