Novel Risk Factors For Vancomycin Resistant Enterococci In Persons With Cancer

癌症患者中万古霉素耐药肠球菌的新危险因素

• 批准号: 8470119
• 负责人: Mini Kamboj
• 金额: $ 13.04万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8470119
• 关键词: Address; Advisory Committees; Affect; Animals; Anti-Bacterial Agents; Antibiotics; Antimicrobial Effect; Antineoplastic Agents; Applications Grants; Biological Assay; Cancer Patient; Caring; Clinical; Clinical Investigator; Clinical Research; Communicable Diseases; Critical Illness; Diagnosis; Diagnostic; Disease; Environment; Failure; Feces; Fluorouracil; Foundations; Genome; Genomics; Goals; Growth; Healthcare; Hematologic Neoplasms; Human; Immunocompromised Host; Immunologic Receptors; In Vitro; Incidence; Individual; Infection; Infection Control; Institution; Laboratories; Malignant Neoplasms; Measures; Medicine; Memorial Sloan-Kettering Cancer Center; Methods; Methotrexate; Microbiological Techniques; Microbiology; Molecular; Morbidity - disease rate; Multi-Drug Resistance; Mus; Natural History; Nosocomial Infections; Organism; Outcome; Pathogenesis; Patients; Persons; Pharmaceutical Preparations; Polymerase Chain Reaction; Population; Predictive Value; Predisposition; Prevalence; Property; Publishing; Regimen; Reporting; Resistance; Resources; Risk; Risk Factors; Role; Series; Supervision; System; Techniques; Technology; Testing; Therapeutic; Time; United States; Vancomycin; Vancomycin resistant enterococcus; Work; antimicrobial; antimicrobial drug; attributable mortality; base; cancer care; cancer therapy; career; chemotherapeutic agent; commensal microbes; density; gastrointestinal; high risk; insight; instructor; methicillin resistant Staphylococcus aureus; microbial; mortality; novel; pathogen; patient oriented; patient population; pressure; professor; programs; transmission process

DESCRIPTION (provided by applicant): This proposal describes a five year program for a clinical research based career in Infectious Diseases. The candidate, Mini Kamboj MD, an Instructor in Medicine and Associate-Director of Hospital Infection Control will conduct the program under the supervision of Dr. Kent Sepkowitz, Professor of Medicine, and Director of the Infection Control Program at Memorial Sloan-Kettering Cancer Center (MSKCC), to study the role of novel risk factors for a multi-drug resistant organism (MDRO) Vancomycin resistant enterococcus (VRE).These infections are more common in persons with cancer and result in devastating outcomes and greater resource utilization. The study will be conducted at MSKCC, one of the largest programs of clinical research in the world. The candidate has enlisted an advisory committee of esteemed leaders in the field of microbial pathogenesis, infection control and genome based testing for guidance and advice during this program. The proposal is guided by the hypothesis that many anti-cancer drugs have anti microbial properties and therefore are likely to influence gastrointestinal flora including the microbial burden (density) of VRE. We also hypothesize that a change in density of VRE in turn has an effect on clinical outcome. To examine this hypothesis we propose to (1)Determine VRE density in stool in 50 cancer patients at MSKCC using a new quantitative PCR assay and standard microbiologic techniques (2) Determine the effect of commonly used chemotherapeutic agents with strong antimicrobial activity, (5-Fluorouracil and Methotrexate) upon density of VRE among colonized individuals. (3) Determine the predictive value of VRE density determined by standard techniques and quantitative PCR on clinical outcome, including mortality and resource utilization, among patients with cancer at highest risk for invasive VRE disease. The candidate's immediate goal is to develop into an independent clinical investigator in patient-oriented clinical research with a focus on hospital acquired infections in persons with cancer and long term goal is to implement studies on devising and testing therapeutic approaches including decolonizing and other control strategies for MDRO's that are common in the cancer population. Hospital-acquired infections are a major cause of morbidity and mortality in persons with cancer. In this population, colonization and infection with vancomycin-resistant enterococci are more common. The studies in this proposal will provide novel insight into common but previously unrecognized risk factors for VRE in persons with cancer and provide a basis for devising and testing control strategies against this multi-drug resistant organism.

描述（由申请人提供）：该提案描述了传染病临床研究职业的五年计划。候选人 Mini Kamboj MD（医学讲师兼医院感染控制副主任）将在纪念斯隆-凯特琳癌症中心医学教授兼感染控制项目主任 Kent Sepkowitz 博士的监督下开展该项目（MSKCC），研究多重耐药菌（MDRO）万古霉素耐药肠球菌（VRE）的新危险因素的作用。这些感染在癌症患者和癌症患者中更为常见。导致破坏性后果和更大的资源利用率。该研究将在 MSKCC 进行，该中心是世界上最大的临床研究项目之一。候选人已招募了一个由微生物发病机制、感染控制和基于基因组的测试领域受人尊敬的领导者组成的咨询委员会，以在该计划期间提供指导和建议。该提案的假设是，许多抗癌药物具有抗微生物特性，因此可能会影响胃肠道菌群，包括 VRE 的微生物负荷（密度）。我们还假设 VRE 密度的变化反过来会对临床结果产生影响。为了检验这一假设，我们建议 (1) 使用新的定量 PCR 测定和标准微生物技术确定 MSKCC 50 名癌症患者粪便中的 VRE 密度 (2) 确定具有强抗菌活性的常用化疗药物的效果，(5-氟尿嘧啶和甲氨蝶呤）对定植个体中 VRE 密度的影响。 (3) 确定通过标准技术和定量 PCR 确定的 VRE 密度对侵袭性 VRE 疾病风险最高的癌症患者的临床结果（包括死亡率和资源利用率）的预测价值。候选人的近期目标是发展成为以患者为导向的临床研究的独立临床研究者，重点关注癌症患者的医院获得性感染，长期目标是实施设计和测试治疗方法的研究，包括去殖民化和其他控制策略MDRO 在癌症人群中很常见。 医院获得性感染是癌症患者发病和死亡的主要原因。在这一人群中，耐万古霉素肠球菌的定植和感染更为常见。该提案中的研究将为癌症患者中常见但以前未被认识的 VRE 危险因素提供新的见解，并为设计和测试针对这种多重耐药微生物的控制策略提供基础。