Endemic and Emerging Multidrug Resistant Organisms in Nursing Homes: A Neglected Clinical Setting

疗养院中流行和新兴的多重耐药微生物：一个被忽视的临床环境

基本信息

批准号：
10537752
负责人：
Gabrielle Gussin
金额：
$ 4.19万
依托单位：
UNIVERSITY OF CALIFORNIA-IRVINE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-06-27 至 2025-06-26
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10537752
关键词：
Acute Address Adverse event Affect American Antibiotic Resistance Antibiotics Bathing Biometry COVID-19 pandemic California Candida auris Caring Case Mixes Characteristics Clinical Clinical Research Communicable Diseases County Data Devices Disease Outbreaks Doctor of Philosophy Environment Environmental Pollution Epidemiology Fellowship Goals Head Health care facility Healthcare Home Nursing Care Hospitals Incontinence Individual Infection Infection prevention Infectious Disease Epidemiology Intensive Care Units Intervention Investigation Link Long-Term Care Measures Mentors Morbidity - disease rate Nursing Homes Oranges Patients Performance Prevalence Prevalence Study Prevention Prospective Studies Public Health Public Health Nursing Quality of Care Research Research Training Resources Risk Risk Factors Sampling Site Sterile coverings Surface Systems Biology Touch sensation Training Universities Virulent Work adverse outcome attributable mortality career comorbidity drug resistant pathogen epidemiology study fungus high risk improved infection risk methicillin resistant Staphylococcus aureus mortality multi-drug resistant pathogen multidisciplinary neglect novel operation pathogen pathogenic fungus patient population population health prevent response screening skills transmission process wound

项目摘要

Project Summary/Abstract Individuals receiving care in nursing homes disproportionally experience adverse outcomes due to multidrug-resistant organisms. This investigation will focus on an endemic and virulent pathogen common to nursing homes – methicillin-resistant Staphylococcus aureus (MRSA), and a highly emerging antibiotic resistant fungus – Candida auris, both of which have been linked to substantial morbidity and mortality in U.S. nursing homes. While MRSA has been a major prevention target in hospitals, little has been done to address this pathogen in nursing homes despite the fact that nursing homes have a 3-fold higher MRSA prevalence than hospitals and MRSA carriers in nursing homes have a 40% risk of infection per year. Risk in nursing homes due to MRSA is now compounded by C. auris, which has been termed the “fungal MRSA” due to similar transmission characteristics, including a remarkable propensity to colonize the body and persist on surfaces for prolonged periods. C. auris has been associated with intractable outbreaks in nursing homes with high attributable mortality; 5-10% of known carriers develop invasive infections and 30- 60% of those with invasive infection die as a result. Thus, determining which nursing home residents are at greatest risk for MRSA and C. auris carriage is crucial for effective response and control. The overall goal of this proposal is to generate novel data on MRSA and C. auris carriage and contamination in nursing homes to inform interventions to control these important pathogens. The first objective is to identify nursing home facility characteristics and resident risk factors associated with MRSA and C. auris carriage. Results from this objective could target high-risk residents for screening and prevention activities. The second objective is to determine if high-contact care activities (e.g., dressing, bathing) for MRSA and C. auris carriers cause contamination of high-touch objects in their immediate environment. If so, focused post-activity cleaning could be important to reduce MRSA and C. auris contamination and mitigate spread. I (Gabrielle Gussin, MS) am pursuing a Ph.D. in Public Health at the University of California, Irvine. This F31 fellowship will enable me to bridge my previous Master’s training in Systems Biology with skills in epidemiology, clinical research, and population health. I will be mentored by a multidisciplinary team with expertise in clinical infectious diseases, epidemiology, multidrug-resistant organisms, public health, nursing home operations, and biostatistics to support my proposed aims and career goals.

项目概要/摘要由于以下原因，在疗养院接受护理的个人不成比例地经历不良后果：这项调查将重点关注常见的地方性和剧毒病原体。疗养院——耐甲氧西林金黄色葡萄球菌 (MRSA) 和一种高度新兴的抗生素抗药性真菌——耳念珠菌，这两种真菌都与美国的大量发病率和死亡率有关。尽管耐甲氧西林金黄色葡萄球菌 (MRSA) 一直是医院的主要预防目标，但在解决该问题方面却几乎没有采取任何措施。尽管疗养院的 MRSA 患病率高出 3 倍，但疗养院中仍然存在这种病原体比医院和疗养院中的 MRSA 携带者每年感染的风险高出 40%。疗养院中由 MRSA 引起的风险现在因耳念珠菌而变得更加复杂，这种细菌被称为“ “真菌 MRSA”由于具有相似的传播特性，包括显着的定殖倾向耳念珠菌长期存在于身体和表面，与顽固性爆发有关。死亡率较高的疗养院；5-10% 的已知携带者会出现侵袭性感染，30- 60% 的侵袭性感染患者因此死亡，因此需要确定哪些疗养院居民在其中。 MRSA 和耳念珠菌携带的最大风险对于有效应对和控制至关重要。该提案的总体目标是生成有关 MRSA 和 C. auris 携带的新数据疗养院的污染情况，为控制这些重要病原体的干预措施提供信息。目的是确定疗养院设施的特征以及与 MRSA 和 MRSA 相关的居民风险因素该目标的结果可以针对高风险居民进行筛查和预防。第二个目标是确定是否存在针对 MRSA 的高接触护理活动（例如穿衣、洗澡）。耳念珠菌携带者会导致其周围环境中频繁接触的物体受到污染。活动后清洁对于减少 MRSA 和耳念珠菌污染并减轻传播非常重要。我（Gabrielle Gussin，硕士）正在加州大学欧文分校攻读公共卫生博士学位。 F31 奖学金将使我能够将之前的系统生物学硕士培训与以下技能联系起来我将得到一个多学科团队的指导，包括流行病学、临床研究和人口健康。临床传染病、流行病学、多重耐药微生物、公共卫生、护理方面的专业知识家庭操作和生物统计学来支持我提出的目标和职业目标。