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.

美国每年大约发生 0.7 至 170 万例医疗保健相关感染 (HAI) 在美国急症护理社区医院接受护理的住院患者。其中许多感染是由 包括多重耐药革兰氏阴性生物体 (MDRGNO) 在内的抗生素耐药生物体。一 耐药微生物感染后发病率和死亡率的主要预测因素是 对感染的经验性和明确的抗生素治疗不足。缺乏具体的临床实践 这些微生物的治疗指南增加了有效治疗策略的模糊性。这是 不清楚 VA 内使用什么治疗方案来治疗 MDRGNO，也不清楚效果如何 他们是。因此，本研究的目标是利用国家 VA 数据来描述当前的治疗策略 对于选定的 MDRGNO（碳青霉烯类耐药肠杆菌科 (CRE)、铜绿假单胞菌和 不动杆菌属）以及这些策略对退伍军人结果的比较有效性。 这项研究与在退伍军人管理局寻求治疗的患者高度相关，因为退伍军人经历了许多风险因素 与 MDRGNO 感染的发生有关。 VA 治疗患有严重复杂病症的患者 需要经常住院或接触医疗保健人员或使用侵入性设备（即脊髓 受伤、截肢），使他们面临感染的风险。 MDRGNOS 和治疗不足会导致 对患有复杂疾病的人的发病率和死亡率结果产生重大影响。另外，建议的 研究与 VA 的多重耐药生物 (MDRO) 计划相关，该计划已开发并 实施国家计划，减少 MRSA 和艰难梭菌的传播和扩散。 我们的研究结果将产生有关 MDRGNO（包括 CRE）结果的有效性数据 退伍军人事务部可以利用退伍军人群体来制定治疗指南。这 据我们所知，该研究具有创新性，因为这将是第一项利用国家 VA 微生物学的研究， 药学和医疗遭遇数据库，以回答以下方面的比较有效性研究问题 MDRGNO 的有效治疗策略。长期目标是为以下方面制定可行的调查结果： 决策者可以实施这些措施来提高治疗和保健的有效性 不同人群的 MDRGNO 感染患者。

项目成果

Meta-analysis of Clinical Outcomes Using Ceftazidime/Avibactam, Ceftolozane/Tazobactam, and Meropenem/Vaborbactam for the Treatment of Multidrug-Resistant Gram-Negative Infections.

使用头孢他啶/阿维巴坦、头孢特洛嗪/他唑巴坦和美罗培南/瓦博巴坦治疗多重耐药革兰氏阴性感染的临床结果的荟萃分析。

• 发表时间: 2021-02
• 影响因子: 4.2
• 作者: Wilson, Geneva M;Fitzpatrick, Margaret;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.

美国退伍军人事务部 (VA) 医疗中心与广泛耐药 (XDR) 不动杆菌相关的流行病学和临床结果。

• 发表时间: 2021
• 影响因子: 4.5
• 作者: Fitzpatrick, Margaret A;Suda, Katie J;Poggensee, Linda;Vivo, Amanda;Wirth, Marissa;Wilson, Geneva;Evans, Martin;Evans, Charlesnika T
• 通讯作者: Evans, Charlesnika T

Infectious Disease Consults of Pseudomonas aeruginosa Bloodstream Infection and Impact on Health Outcomes.

铜绿假单胞菌血流感染及其对健康结果的影响的传染病咨询。

• 发表时间: 2022-09
• 影响因子: 4.2
• 作者: Ramanathan, Swetha;Albarillo, Fritzie S;Fitzpatrick, Margaret A;Suda, Katie J;Poggensee, Linda;Vivo, Amanda;Evans, Martin E;Jones, Makoto;Safdar, Nasia;Pfeiffer, Chris;Smith, Bridget;Wilson, Geneva;Evans, Charlesnika T
• 通讯作者: Evans, Charlesnika T

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

服用新批准的抗生素，用于耐碳青霉烯类肠杆菌 (CRE) 患者。

• 发表时间: 2023-04
• 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

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

美国退伍军人事务部 (VA) 医疗中心广泛耐药 (XDR) 不动杆菌的治疗及其对临床结果的影响。

• 发表时间: 2022-09
• 影响因子: 4.9
• 作者: Fitzpatrick, Margaret A;Suda, Katie J;Poggensee, Linda;Vivo, Amanda;Wilson, Geneva;Jones, Makoto M;Evans, Martin;Safdar, Nasia;Evans, Charlesnika T
• 通讯作者: Evans, Charlesnika T