MDRO Carriage, Transmission, Sequelae, and Prevention in Nursing Homes

疗养院中 MDRO 的携带、传播、后遗症和预防

• 批准号: 10549487
• 负责人: Susan S. Huang
• 金额: $ 285.31万
• 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/10549487
• 关键词: Address; Affect; Area; California; Candida auris; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Communicable Diseases; Communities; Containment; County; Data; Disease; Ecosystem; Environment; Environmental Pollution; Epidemiology; Equipment; Evaluation; Extended-spectrum β-lactamase; Genomics; Health; Health care facility; Healthcare; Home Nursing Care; Hospitalization; Hospitals; Human; Human Microbiome; Individual; Infection; Infection prevention; Integration Host Factors; Intervention; Investments; Long-Term Care; Long-Term Care Nursing; Measures; Metagenomics; Methods; Microbiology; Modeling; Morbidity - disease rate; Multi-Drug Resistance; Nursing Homes; Oranges; Organism; Outcome; Pattern; Persons; Policies; Population; Prevalence; Prevention; Prevention Guidelines; Prevention strategy; Program Research Project Grants; Resistance; Risk; Risk Factors; Role; Route; Sampling; Science; Source; System; United States; Vancomycin resistant enterococcus; Vancomycin-resistant S. aureus; acute care; carbapenem resistance; community-level factor; comorbidity; economic disparity; effective intervention; epidemiologic data; ethnic disparity; fungus; genomic data; health economics; hospital care; medical vulnerability; methicillin resistant Staphylococcus aureus; models and simulation; mortality; multi-drug resistant pathogen; multimodality; pathogen; pathogen genomics; programs; prospective; racial disparity; simulation; statistics; transmission process; wound

Abstract Overview: MDRO Carriage, Transmission, Sequelae, and Prevention in Nursing Homes This P01 Program proposal will address critically important questions surrounding the expanding problem of multidrug-resistant organisms (MDROs) in nursing homes (NH). Of the 1.4 million residents residing annually in 15,000 U.S. NHs, more than half (65%) are estimated to harbor MDROs. These MDROs not only impact medically vulnerable residents in NHs, but they can spread to surrounding hospitals and long-term care facilities, causing significant morbidity and mortality. Despite growing evidence that NHs are major reservoirs of MDROs, investments to address MDROs in this health sector are lacking. Little is known about sources or drivers of MDRO transmission, and identification of effective interventions is needed. This program integrates expertise in infectious diseases, epidemiology, microbiology, pathogen genomics, human microbiome, statistics, systems science, health economics, and agent-based models to conduct an unprecedented set of studies on five MDROs in NHs – methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum beta-lactamase producers (ESBLs), carbapenem-resistant Enterobacterales (CRE) and the newly-emerged resistant fungus, Candida auris. By leveraging previous and newly-conducted studies, this program will provide one of the largest compilations of MDRO isolates from NH residents and environmental fomites. A total of 16,000 MDRO isolates and 3,000 metagenomic samples from 50 NHs will be studied using epidemiology, genomics, and simulation modeling as distinct and synergistic vantage points to elucidate 1) best sampling methods for MDRO carriage and co- carriage, 2) key sources and drivers of MDRO transmission, 3) major risk factors associated with carriage, infection, and hospitalization, and 4) high-yield interventions to inform infection prevention policies to mitigate adverse health outcomes due to MDROs in NHs.

抽象的 概述：疗养院中 MDRO 的传播、传播、后遗症和预防 该 P01 计划提案将解决围绕不断扩大的 疗养院 (NH) 的 140 万居民中存在多重耐药菌 (MDRO) 问题。 每年在 15,000 个美国国家医疗机构中，估计超过一半 (65%) 不仅藏匿着这些 MDRO。 影响新罕布什尔州医疗弱势居民，但可能会蔓延到周边医院和长期护理中心 尽管越来越多的证据表明 NH 是主要的储存库，但仍造成了严重的发病率和死亡率。 对于该卫生部门的多重耐药性问题，以及解决多重耐药性问题的投资，人们知之甚少。 多重耐药菌传播的驱动因素，并需要确定有效的干预措施。 该项目整合了传染病、流行病学、微生物学、病原体方面的专业知识 基因组学、人类微生物组、统计学、系统科学、健康经济学和基于代理的模型 对 NH 中的五种多重耐药菌（耐甲氧西林金黄色葡萄球菌）进行了前所未有的研究 (MRSA)、耐万古霉素肠球菌 (VRE)、超广谱 β-内酰胺酶产生菌 (ESBL)、 耐碳青霉烯类肠杆菌（CRE）和新出现的耐药真菌耳念珠菌。 利用以前和新进行的研究，该计划将提供最大的汇编之一 从新罕布什尔州居民和环境污染物中分离出的多重耐药菌 共有 16,000 种多重耐药菌分离株和 3,000 种。 来自 50 个国家的宏基因组样本将使用流行病学、基因组学和模拟模型进行研究，如下所示： 阐明 1) MDRO 携带和协同的最佳采样方法的独特和协同优势 携带，2) 多重耐药菌传播的主要来源和驱动因素，3) 与携带相关的主要风险因素， 感染和住院治疗，以及 4) 高产干预措施，为感染预防政策提供信息，以减轻 NH 中 MDRO 造成的不良健康后果。