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: 8730127
• 负责人: Stephanie Ann Fritz
• 金额: $ 49.49万
• 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 2015-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8730127
• 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）：社区相关的耐甲氧西林金黄色葡萄球菌 (CA-MRSA) 在美国和其他国家流行，造成了重大的健康和经济负担。由于 CA-MRSA 目前是社区和许多医疗机构中主要的 MRSA 克隆，临床医生和感染控制从业人员面临着新的挑战。该社区现在是致命的 CA-MRSA 菌株向医院传播的重要且不断扩大的储存库，可能会增加医院内 MRSA 感染的严重程度。现有的感染预防策略基于与传统医疗相关 MRSA 菌株传播相关的风险因素。为了有效减缓当代 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性克隆的传播动态，确定与获得和感染相关的因素，并确定环境表面污染在病毒传播中的重要性。有机体。 CA-MRSA 感染在家庭中的聚集使得这成为研究 CA-MRSA 传播动态的合理背景。我们之前的研究显示，在患有 MRSA 疾病的儿童的家庭接触者中，MRSA 定植率很高，并证明，与所有家庭成员的去定植相比，所有家庭成员的去定植导致指示患者和家庭接触者的皮肤和软组织感染 (SSTI) 发生率降低。单独索引患者。 CA-MRSA 感染儿科患者及其家庭成员将被招募参加一项为期一年的 CA-MRSA 家庭传播动态前瞻性自然史研究。常用的家庭物品和表面以及宠物狗和猫将被培养。参与者的连续定植状态和感染发生率将在 12 个月内确定。将对所有回收的 MRSA 分离株进行分子分型，以阐明传播的方向性，并确定感染菌株是否类似于内源定植菌株、从家庭接触中回收的菌株或从环境表面回收的菌株。使用混合效应逻辑回归模型，将阐明多个层面的风险因素之间的关系（包括家庭定植压力、宿主行为习惯以及家庭表面和宠物的污染），以确定导致 CA-MRSA 定植、感染的最大风险的因素和传输。随后，研究参与者将被随机分配到一项干预研究中，以比较非殖民化措施（使用莫匹罗星鼻腔和稀释漂白剂水浴）在预防复发性 SSTI 方面的有效性，当这些措施由所有家庭成员执行时，与仅对有特定家庭成员的非殖民化措施进行比较。上一年的 SSTI 历史（在自然历史研究期间确定）。定植状态和感染发生率将被额外跟踪 12 个月。这些研究将为优化干预措施提供信息，以减轻 CA-MRSA 定植和疾病的负担。