Recurrent MRSA Infections: A Study of Risk Factors and Molecular Epidemiology

复发性 MRSA 感染：危险因素和分子流行病学研究

• 批准号: 8660603
• 负责人: Michael Zdenek David
• 金额: $ 12.66万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8660603
• 关键词: Aftercare; Anatomic Sites; Antibiotic Therapy; Antibiotics; Biology; Blood; Caring; Case-Control Studies; Characteristics; Chicago; Chronic; Clinical; Cohort Studies; Collection; Communicable Diseases; Communities; Comorbidity; Complement; Databases; Diagnosis; Disease; Ecology; Enrollment; Environment; Epidemic; Epidemiology; Exposure to; Future; Gastrointestinal tract structure; Genetic; Genetic Predisposition to Disease; Genotype; Goals; HIV; Healthcare; Healthcare Systems; Household; Human; Incidence; Individual; Infection; Intervention; Jail; Life; Literature; Medical; Medical Records; Medical center; Modality; Molecular Epidemiology; Monitor; Monobactams; Nose; Organism; Patients; Pneumonia; Population; Predisposition; Prospective Studies; Protocols documentation; Recurrence; Recurrent disease; Reporting; Research; Research Personnel; Risk; Risk Factors; Role; Safety; Sepsis; Site; Skin; Skin Tissue; Soft Tissue Infections; Specialist; Staphylococcus aureus; Surveillance Program; Techniques; Time; United States; Universities; Vaccines; burden of illness; clinical epidemiology; cohort; demographics; high risk; medical attention; men who have sex with men; methicillin resistant Staphylococcus aureus; microbial; pathogen; patient oriented; prevent; prospective; public health relevance; resistant strain; skills; stem; surveillance data

DESCRIPTION (provided by applicant): Staphylococcus aureus is among the most common bacterial pathogens in human beings. The epidemiology of methicillin-resistant S. aureus (MRSA), which are strains resistant to all ¿-lactam antibiotics, has changed dramatically in the past fifteen years. While MRSA infections before that time occurred almost exclusively within the health care environment and in patients with health care exposure, since the mid-1990s, new strains of MRSA have arisen that are causing an epidemic of infections in the community, particularly skin and soft tissue infections but also less common severe, invasive infections. These community-associated (CA-) MRSA strains differ from the older healthcare-associated (HA-) MRSA strains in the population that they infect, in the type of infections that they cause, and in the genetic characteristics of the strains themselves. MRSA is often a commensal organism, living on the skin, in the gastrointestinal tract, and in the nose of individuals, and asymptomatic carriage is thought to be common before an infection occurs. MRSA infections often recur in patients, but it is not known which patients are at highest risk for recurrence nor whether CA- or HA-strains are more likely to cause recurrence. In the era of CA-MRSA, it is not known if patients with persistent carriage of MRSA are at elevated risk of recurrent MRSA infections. There are interventions that may decrease the likelihood of recurrent MRSA infections in an individual: decolonization protocols, cleaning of fomites, antibiotic therapies, and vaccines are all potentially relevant avenues for the future control of MRSA in the community. Each of these modalities will require further study to assess its efficacy and safety. Patients with recurrent MRSA disease are likely to benefit from such interventions, and the control of MRSA infections in this population may be critical to stemming the dissemination of CA-MRSA in the U.S. In this a two-part study, using a collection of >13,800 stored clinical S. aureus strains, obtained through surveillance at the University of Chicago Medical Center (UCMC), I will attempt to define risk factors for recurrent MRSA infections. First, using existing surveillance data from UCMC in 2003-9, in a case-control study treating those with multiple infections as the cases and those with a single infection as controls, I will examine the following as risk factors for re- infection: anatomic site of first infection, genotype of first and subsequent infecting MRSA strains including CA- and HA-MRSA strain characteristics, patient demographic characteristics, previous exposures to the health care system, and patient comorbidities. Second, nesting a prospective cohort study of recurrent MRSA infections in surveillance at UCMC, I will enroll 400 patients with incident MRSA infections and monitor them for two years. I will determine how frequently these patients have recurrent MRSA infections, how commonly they seek medical attention for the infections, the presence of the risk factors for re-infection listed above, and the genotypes of MRSA strains associated with infections and any identified asymptomatic colonization to assess the role of chronic colonization in the recurrence of MRSA infections. Public Health Relevance: Infections caused by methicillin-resistant Staphylococcus aureus (MRSA), once limited to patients with exposures to the health care system, are becoming common in the healthy population of the United States. While many people have recurrent skin, blood or other MRSA infections after treatment for a first infection, it is not known which patients are at high risk for such recurrences. The goal of this study is to determine the risk factors that predict recurrent MRSA infections by studying the demographics, medical treatments given, and medical problems of MRSA patients, the types of infection caused by MRSA, and the genetic characteristics of MRSA strains that cause initial and recurrent infections.

描述：葡萄球菌是人类最常见的巴氏病原体之一。 - lactam抗生素在过去的15年中发生了巨大变化，而MRSA感染几乎完全在医疗保健环境中发生，并且患有医疗保健的患者，因为1990年代中期感染也降低了与侵入性感染。菌株在皮肤上生活，在胃部，在鼻子中，无症状的马车在urrence发生之前也被认为是ca-orrence。 MRSA，毫无疑问，MRSA的行李均具有复发的MRSA感染的风险和安全性MRSA疾病的患者可能会受益于这种人群对美国的指定为CA-MRSA至关重要（UCMC），我将尝试使用2003 - 9年的现有监视数据来定义复发的MRSA感染。重新释放的因素，将ca和ha-mrsa菌株特征，患者人口统计学特征，先前对医疗保健系统的暴露和患者合并症的因素。在UCMC的监视中，我将招募400例出现MRSA感染的患者，并确定这些患者经常患有MRSA感染的频率，他们通常如何寻求感染的医疗服务，重新感染的风险因素上面列出了上面的Nfections和任何鉴定出的无症状定植，以评估慢性定殖在MRSA感染复发中的作用。 公共卫生相关性：由耐甲氧西林的金黄色葡萄球菌（MRSA）导致的感染在美国的健康流行中很普遍。复发。通过研究MRSA患者的人口统计学，医疗治疗和医疗问题，MRSA引起的感染类型以及MRSA菌株的遗传特征来预测MRSA感染的危险因素。