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 MDRO 携带和不良健康后果的流行病学 多重耐药微生物（MDRO）对人类健康构成严重而紧迫的威胁。 医院广泛开始扭转颓势，护理投资严重缺乏 MDRO 患病率更高的家庭 (NH)（一般为 65%，而 NH 中则为 10%）。 由于停留时间长、护理等原因，可能特别容易传播传染病的环境 医疗弱势居民、鼓励共享空间和活动、人员流动率高以及有限 由于筛查、监测和应对策略的资源稀缺。 MDRO，需要证据来制定专门针对 NH 的 MDRO 减少策略指南。 该项目将包括对五种主要临床多重耐药菌（MDRO）进行深入、同步的评估。 对于每年在 15,000 家美国疗养院接受护理的 140 万人来说意义重大。 MDROs 包括三种根植于 NH 中的地方性病原体，即耐甲氧西林病原体 金黄色葡萄球菌 (MRSA)、耐万古霉素肠球菌 (VRE) 和超广谱 β- 内酰胺酶生产者 (ESBL) 以及两种新兴的 MDRO——碳青霉烯类耐药肠杆菌 （CRE）和耳念珠菌（Candida auris），一种具有很高发病率和死亡率的抗生素抗性真菌。 同时评估这些 MDRO 的目标是评估筛选培养物的协同捕获 并为针对多重耐药菌的干预措施提供信息。 我们将利用涉及超过 10,000 名 NH 的回顾性和前瞻性研究相结合 来自 50 个新罕布什尔州的居民评估对 MDRO 的身体部位和环境物体进行采样的有效方法 我们还将对居民、NH 和社区进行全面评估。 单独或组合携带多重耐药菌的风险因素 除了携带之外，我们还将使用这些数据来确定携带多重耐药菌的风险因素。 评估后期 MDRO 感染和住院的危险因素 重要的是，我们将专门评估。 风险因素是否受到种族、民族和社会经济地位的不同影响，以更好地阐明 NH 在护理服务或健康结果方面的差异将导致传播和感染的主要驱动因素。 告知 NH 干预措施的必要性和价值，以改变政策和实践。