Risk of Infectious Complications in Nosocomial Pneumonia

院内肺炎感染并发症的风险

• 批准号: 7060031
• 负责人: DARREN R. LINKIN
• 金额: $ 13.25万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-01 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7060031
• 关键词: antibiotics; clinical research; disease /disorder onset; disease /disorder proneness /risk; disease /therapy duration; drug adverse effect; drug resistance; epidemiology; gram negative bacteria; human data; human mortality; iatrogenic disease; intensive care; medical records; microbiology; nosocomial infections; opportunistic infections; patient oriented research; pneumonia; postdoctoral investigator; respiratory infections

DESCRIPTION (provided by applicant): Darren Linkin, M.D. is a post-doctoral research fellow in Infectious Diseases at the University of Pennsylvania and a student in the Masters of Science in Clinical Epidemiology in the Center for Clinical Epidemiology and Biostatistics (CCEB). Emerging infections and antimicrobial drug use are his main research focus; an integrated five-year educational and research program is proposed to facilitate his growth as a successful independent clinical investigator in the field. The training plan includes outstanding mentorship from an international expert in pharmacoepidemiology and input from a diverse team of experienced clinical investigators. Advanced coursework will be performed in epidemiology, quasi-experimental studies, clinical trials, and pharmacoepidemiology. Hospital-acquired pneumonia (HAP) is a common disease that confers high mortality, yet it is relatively poorly understood. Only recently have any studies attempted to determine how superinfections additional infections arising during treatment for HAP--contribute to its mortality. Superinfection has been associated with a two-fold increase in mortality of HAP. Death in a significant proportion of HAP patients may also be due to subsequent extra-pulmonary infections. The specific aims of this proposal are to: 1) describe the epidemiology of clinical superinfection in intensive care unit (ICU) patients treated for HAP, 2) determine risk factors for clinical superinfection in HAP patients in the ICU, and 3) determine the impact of superinfection on in-hospital mortality in these patients. ICU patients with HAP will be enrolled into a prospective cohort. Exposures to be examined include duration and spectra of antibiotic use, and severity of illness as measured by Apache II score. Superinfection and extra-pulmonary infection will be defined by both clinical and microbiological criteria. A Cox proportional hazards model will be used to determine independent risk factors for superinfection, as well as the effect of superinfection and other factors on death. The proposed study will further our understanding of the biology of superinfection, add to clinical knowledge guiding the treatment of HAP, and lay the groundwork for future interventional studies to improve outcomes in HAP patients and other patients at risk for infectious complications of antimicrobial therapy.

描述（由申请人提供）：医学博士Darren Linkin是宾夕法尼亚大学传染病的博士后研究员，也是临床流行病学和生物统计学中心临床流行病学临床流行病学硕士学位的学生。他的主要研究重点是新兴的感染和抗菌药物使用。提出了一项综合的教育和研究计划，以促进他作为该领域的成功独立临床研究者的成长。该培训计划包括来自国际药物电子学专家的杰出指导以及一组经验丰富的临床研究人员团队的投入。高级课程将在流行病学，准实验研究，临床试验和药物ePidemiology中进行。 医院获得的肺炎（HAP）是一种赋予高死亡率的常见疾病，但对此却相对较少。直到最近，任何研究都试图确定超级感染在治疗过程中如何与其死亡率相结合的其他感染。 超级感染与HAP死亡率增加了两倍。大部分HAP患者的死亡也可能是由于随后的肺外感染。该提案的具体目的是：1）描述接受HAP治疗的重症监护病房（ICU）患者临床超级感染的流行病学，2）确定ICU中HAP患者临床超级感染的危险因素，3）确定影响这些患者对住院死亡率的超级感染。 ICU HAP患者将招收前瞻性队列。要检查的暴露包括持续时间和使用抗生素的持续时间和疾病的严重程度，如Apache II评分所测量。临床和微生物标准将定义超级感染和肺外感染。 COX比例危害模型将用于确定超级感染的独立危险因素，以及超级感染和其他因素对死亡的影响。 拟议的研究将进一步了解我们对超级感染生物学的理解，增加指导HAP治疗的临床知识，并为将来的介入研究奠定基础，以改善HAP患者和其他有抗菌疗法感染并发症风险的患者的预后。