EPIDEMIOLOGY AND ERADICATION OF MRSA IN HOUSEHOLDS WITH CHILDREN

有儿童家庭中 MRSA 的流行病学和根除

• 批准号: 8534776
• 负责人: Stephanie Ann Fritz
• 金额: $ 49.77万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2017-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8534776
• 关键词: EPIDEMIOLOGY; ERADICATION; MRSA; HOUSEHOLDS; CHILDREN

DESCRIPTION (provided by applicant): Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is epidemic in the United States and other countries and poses a significant health and economic burden. As CA-MRSA is now the predominant MRSA clone in the community and in many healthcare settings, clinicians and infection control practitioners face new challenges. The community is now an important and expanding reservoir for the spread of virulent CA-MRSA strains into hospitals, likely increasing the severity of nosocomial MRSA infections. Existing infection prevention strategies are based on risk factors associated with the transmission of traditional healthcare-associated MRSA strains. To effectively mitigate the spread of contemporary CA- MRSA strains in both healthcare and community settings, we must first understand the transmission dynamics of this epidemic clone, identify factors associated with acquisition and infection, and determine the significance of environmental surface contamination in the spread of the organism. The clustering of CA-MRSA infections in households makes this a logical setting in which to study CA- MRSA transmission dynamics. Our prior studies revealed a high prevalence of MRSA colonization in household contacts of children with MRSA disease and demonstrated that decolonization of all household members resulted in a decreased incidence of skin and soft tissue infection (SSTI) in index patients and household contacts compared to decolonization of the index patient alone. Pediatric patients with CA-MRSA infection and their household members will be recruited to participate in a one-year prospective natural history study of CA-MRSA household transmission dynamics. Commonly handled household objects and surfaces, and pet dogs and cats, will be cultured. Serial colonization status and infection incidence in participants will be ascertained over 12 months. Molecular typing will be performed on all recovered MRSA isolates to illuminate the directionality of transmission and to determine whether infecting strains resemble endogenous colonizing strains, strains recovered from household contacts, or strains recovered from environmental surfaces. Using mixed effects logistic regression modeling, the relationships among risk factors at multiple levels (including household colonization pressure, host behavioral practices, and contamination of household surfaces and pets) will be elucidated to identify factors conferring the greatest risks for CA-MRSA colonization, infection, and transmission. Subsequently, study participants will be randomized into an intervention study to compare the effectiveness of decolonization measures (application of nasal mupirocin and dilute bleach water baths) in preventing recurrent SSTI when these measures are performed by all household members compared to decolonizing only household members with a history of SSTI in the prior year (as determined during the natural history study). Colonization status and infection incidence will be followed for an additional 12 months. These studies will inform optimized interventions to reduce the burden of CA-MRSA colonization and disease.

描述（由申请人提供）：与社区相关的甲氧西林金黄色葡萄球菌（CA-MRSA）在美国和其他国家是流行病，并带来了巨大的健康和经济负担。由于CA-MRSA现在是社区中主要的MRSA克隆，并且在许多医疗保健环境中，临床医生和感染控制从业者都面临着新的挑战。现在，该社区是将有毒的CA-MRSA菌株传播到医院中的重要且不断扩大的水库，可能会增加医院MRSA感染的严重程度。现有的预防策略基于与传统医疗保健相关MRSA菌株的传播相关的风险因素。为了有效地减轻当代CA-MRSA菌株在医疗保健和社区环境中的传播，我们必须首先了解这种流行病克隆的传播动力学，确定与获取和感染相关的因素，并确定环境表面在有机疾病传播中的显着性。 家庭中CA-MRSA感染的聚类使这是研究CA-MRSA传播动态的逻辑环境。我们先前的研究表明，MRSA疾病儿童的家庭接触中MRSA定殖率很高，并且证明所有家庭成员的非殖民化导致与单独的指数患者分离的指数患者和家庭接触的皮肤和软组织感染（SSTI）的发生率降低。患有CA-MRSA感染的儿科患者及其家庭成员将被招募，以参加一项为期一年的CA-MRSA家庭传播动力学的预期自然史研究。通常会培养经常处理的家庭物体和表面以及宠物狗和猫。在12个月内，将确定参与者的连续定殖状况和感染发生率。将对所有回收的MRSA分离株进行分子键入，以阐明传播的方向性，并确定感染菌株是否类似于内源性定殖菌株，从家庭接触中回收的菌株或从环境表面回收的菌株。使用混合效应的逻辑回归模型，将阐明多个级别的风险因素之间的关系（包括家庭定植压力，宿主行为实践以及对家庭表面和宠物的污染），以识别赋予CA-MRSA定植，感染和传播风险最大风险的因素。随后，研究参与者将被随机分为一项干预研究，以比较非殖民化度量的有效性（应用鼻莫皮罗辛和稀释水浴）在防止在所有家庭成员执行这些措施的情况下，与仅在自然历史研究中SSTI的家庭成员相比，所有家庭成员都执行这些措施时，所有家庭成员都进行了这些措施的有效性。定植状态和感染发生率将持续12个月。这些研究将为优化的干预措施提供信息，以减轻CA-MRSA定殖和疾病的负担。