Southeastern Pennsylvania Adult and Pediatric Prevention Epicenter Network

宾夕法尼亚州东南部成人和儿童预防中心网络

• 批准号: 9043126
• 负责人: EBBING LAUTENBACH
• 金额: $ 80万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2016-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9043126
• 关键词: Southeastern; Pennsylvania; Adult; Pediatric; Prevention

DESCRIPTION (provided by applicant): Healthcare-associated infections (HAIs), particularly those due to antimicrobial-resistant pathogens, are very common and are associated with significant increases in morbidity, mortality, and cost. Antimicrobial resistance has increased markedly in recent years due to overuse of antimicrobials. However, efforts to limit unnecessary antibiotic use have met with little success. Inappropriate antibiotic use is largely driven by the inability to identify conditions for which empiric antibiotics are unnecessary. The role of biomarkers in informing decisions to stop antibiotic therapy remains unclear, especially in critically ill adults. Even fewer studies have been conducted in children. The economic impact of biomarker interventions is unknown. The goal of this project is to reduce unnecessary antibiotic use in the intensive care unit (ICU) setting. Phase I of the study will identify the biomarker(s) that best identify critically ill patients who have a very low likelihood of bacterial infection. In Phase II, the impact of a biomarker-based algorithm on reducing antibiotic use will be tested. Finally, we will expand the scope of the Delaware Valley Case Control Network (DVCCN) to address future CDC Prevention Epicenter initiatives. The specific study phases and aims are: Phase I: Test Characteristics of Candidate Biomarkers Aim 1: to assess the test characteristics of candidate biomarkers for identifying patients with very low likelihood of bacterial infection among critically ill adults Aim 2: to assess the test characteristics of candidate biomarkers for identifying patients with very low likelihood of bacterial infection among critically ill children The hypotheses for Aims 1 and 2 are that a biomarker or combination of biomarkers can be identified that demonstrates a high negative predictive value for bacterial infection Phase II: Impact of a Biomarker-Based Algorithm on Antibiotic Use Aim 3: to evaluate the impact of a biomarker-based algorithm on reducing antibiotic use in critically ill adults Aim 4: to evaluate the impact of a biomarker-based algorithm on reducing antibiotic use in critically ill children The hypotheses for Aims 3 and 4 are that use of the biomarker-based algorithm will be associated with significant reductions in antibiotic use Secondary Aim 1: to determine incremental costs (savings) of the biomarker algorithm in adults Secondary Aim 2: to determine incremental costs (savings) of the biomarker algorithm in children Aim 5: to expand the scope of the DVCCN for future CDC Prevention Epicenter initiatives This work will provide crucial insights into the potential impact of biomarker-based algorithms on reducing unnecessary antibiotic use in critically ill patients. The well-established DVCCN collaborative will provide an exceptional network of clinical sites within which to conduct future CDC Prevention Epicenter initiatives

描述（由申请人提供）：与医疗保健相关的感染（HAI），特别是由于抗菌病原体引起的病原体，非常普遍，并且与发病率，死亡率和成本的显着升高相关。近年来，由于抗菌剂过度使用，抗菌素的耐药性显着增加。但是，限制不必要的抗生素使用的努力几乎没有成功。不适当的抗生素使用在很大程度上是由于无法确定不必要的经验性抗生素的条件所驱动的。生物标志物在告知制定抗生素疗法的决策中的作用尚不清楚，尤其是在重病的成年人中。在儿童中进行的研究甚至更少。生物标志物干预措施的经济影响尚不清楚。 该项目的目的是减少重症监护病房（ICU）设置中不必要的抗生素使用。该研究的第一阶段将确定最能识别细菌感染可能性很小的重症患者的生物标志物。在第二阶段，将测试基于生物标志物的算法对减少抗生素使用的影响。最后，我们将扩大特拉华谷案例控制网络（DVCCN）的范围，以解决未来的预防疾病中心倡议。具体的研究阶段和目标是：第一阶段：候选生物标志物的测试特征1：评估候选生物标志物的测试特征，以识别患有非常低的细菌感染可能性的患者，成年人之间细菌感染的可能性很小可以鉴定出生物标志物或生物标志物的组合，以证明细菌感染的高负预测价值II期：基于生物标志物的算法对抗生素使用的影响3：评估基于生物标志物的算法对降低基于生物疾病的抗生素在生物疾病中的影响的影响4：评估基于生物疾病的抗生素的影响4：评估生物植物的目标4： in critically ill children The hypotheses for Aims 3 and 4 are that use of the biomarker-based algorithm will be associated with significant reductions in antibiotic use Secondary Aim 1: to determine incremental costs (savings) of the biomarker algorithm in adults Secondary Aim 2: to determine incremental costs (savings) of the biomarker algorithm in children Aim 5: to expand the scope of the DVCCN for未来的预防疾病预防中心倡议这项工作将为基于生物标志物算法对减少危重患者的不必要抗生素使用的潜在影响提供至关重要的见解。成熟的DVCCN协作将提供一个卓越的临床网站网络，以在其中进行未来的CDC预防epicenter计划