Comparative Effectiveness of Strategies to Control S. aureus Infections

控制金黄色葡萄球菌感染策略的比较有效性

• 批准号: 8484107
• 负责人: Marin Leigh Schweizer
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8484107
• 关键词: Accounting; Antibiotic Resistance; Antibiotic Therapy; Antibiotics; Bacteria; Bacterial Infections; Blood; Brain; Cephalosporins; Cessation of life; Cohort Studies; Communicable Diseases; Consensus; Data; Databases; Decision Modeling; Development; Dialysis patients; Disadvantaged; Effectiveness; Environment; Generations; Goals; Health Services; Healthcare; Healthcare Systems; Hospitals; Human; Infection; Infection prevention; Inferior; Intervention; Literature; Lung; Medical center; Meta-Analysis; Methicillin; Methods; Mission; Modification; Monobactams; Morbidity - disease rate; Nose; Outcome; Patients; Phase; Physicians; Prevalence; Prevention; Prevention strategy; Research; Research Personnel; Research Proposals; Resistance; Resources; Staphylococcus aureus; Symptoms; System; Testing; Time; Training; Vancomycin; Veterans; Work; career; comparative effectiveness; compare effectiveness; cost; cost effective; cost effectiveness; effectiveness research; evidence base; health administration; high risk; implementation science; improved; mathematical model; methicillin resistant Staphylococcus aureus; mortality; patient population; prevent; public health relevance; research study; systematic review; transmission process; treatment strategy

DESCRIPTION (provided by applicant): Staphylococcus aureus infections are associated with considerable morbidity and mortality in hospitals worldwide including the VA Healthcare System. Dr. Schweizer's long term career goal is to develop and evaluate evidence based strategies to reduce the prevalence of and poor outcomes associated with healthcare-associated infections in the VA Healthcare System. The purpose of this application is to provide Dr. Schweizer with opportunities for specific training in comparative effectiveness research, use of national VA databases, mathematical modeling of infectious diseases, and implementation science to assist in her development as an independent VA health services researcher specializing in hospital-associated infection prevention. The objective of this application is to compare the effectiveness of strategies to prevent and treat S. aureus infections. Multiple organization-level and patient-level strategies have been proposed for S. aureus prevention and treatment. Unfortunately, all have advantages and disadvantages, and there is little evidence to support the effectiveness of these strategies. The current literature assessing strategies to prevent S. aureus transmission often lack external validity, thus it is difficult to apply study results to different patient populations. In 2007, th Veterans Health Administration (VHA) Methicillin-resistant S. aureus (MRSA) Prevention Initiative mandated that all VA Medical Centers test the noses of all admitted patients for MRSA and limit contact with MRSA positive patients in order to prevent MRSA spread. However, few studies have compared this strategy to other potential strategies to determine if this is the most effective and cost-effective strategy to reduce transmission. MRSA is an antibiotic resistant form of S. aureus and comprises approximately half of all S. aureus infections. Thus, strategies that aim to prevent both MRSA and methicillin-susceptible S. aureus (MSSA) may be more effective than strategies solely focused on MRSA. Additionally, there is little consensus on the optimal treatment for S. aureus infections. Many physicians prescribe the antibiotic vancomycin for all S. aureus infections although this may not be optimal. The three aims of this research proposal are: 1) Complete a systematic review and meta-analysis of the effectiveness and costs of different organization-level S. aureus infection prevention strategies implemented: a) Among all admitted patients; b) Among patients who are transitioning through the healthcare system; 2) Compare the effectiveness of vancomycin to that of other anti-staphylococcal antibiotics for the treatment of invasive S. aureus (MRSA and MSSA) infections; and 3) Using organization-level and patient-level data collected in Aims 1 and 2, create a decision model to compare the effectiveness, costs, and cost-effectiveness of strategies to prevent and treat S. aureus infections. The VHA has invested considerable time and resources into the prevention of MRSA transmission and infection through the VHA MRSA Prevention Initiative. This study is consistent with the mission of the VHA in attempting to determine the most effective and cost-effective strategies that can be implemented by the VHA MRSA Prevention Initiative to prevent and treat S. aureus (including MRSA) infections. Thus preventing S. aureus related morbidity and mortality among our nation's veterans. This study will utilize a meta-analysis, a large VA retrospective cohort study, and mathematical models to assess the most effective and cost- effective strategies to reduce transmission, infection, and mortality related to S. aureus. These data are integral to the prevention and treatment of S. aureus invasive infections.

描述（由申请人提供）： 金黄色葡萄球菌感染与世界各地医院（包括退伍军人管理局医疗系统）的高发病率和死亡率相关。 Schweizer 博士的长期职业目标是制定和评估基于证据的策略，以减少 VA 医疗系统中与医疗保健相关的感染的患病率和不良结果。此应用程序的目的是为 Schweizer 博士提供在比较有效性研究、使用国家 VA 数据库、传染病数学建模和实施科学方面进行专门培训的机会，以协助她发展成为一名独立的 VA 卫生服务研究员，专门从事预防医院相关感染。本申请的目的是比较预防和治疗金黄色葡萄球菌感染的策略的有效性。已经提出了多种组织层面和患者层面的金黄色葡萄球菌预防和治疗策略。不幸的是，所有这些策略都有优点和缺点，并且几乎没有证据支持这些策略的有效性。 目前预防金黄色葡萄球菌传播的文献评估策略往往缺乏外部效度，因此很难将研究结果应用于不同的患者群体。 2007 年，退伍军人健康管理局 (VHA) 耐甲氧西林金黄色葡萄球菌 (MRSA) 预防计划要求所有退伍军人管理局医疗中心对所有入院患者进行鼻子 MRSA 检测，并限制与 MRSA 阳性患者的接触，以防止 MRSA 传播。然而，很少有研究将该策略与其他潜在策略进行比较，以确定这是否是最有效的。 减少传播的有效且具有成本效益的策略。 MRSA 是一种抗生素耐药性形式 约占所有金黄色葡萄球菌感染的一半。因此，旨在预防 MRSA 和甲氧西林敏感金黄色葡萄球菌 (MSSA) 的策略可能比仅针对 MRSA 的策略更有效。此外，对于金黄色葡萄球菌感染的最佳治疗方法几乎没有达成共识。许多医生为所有金黄色葡萄球菌开出抗生素万古霉素。 金黄色葡萄球菌感染，尽管这可能不是最佳的。本研究提案的三个目标是： 1) 对以下实施的不同组织级别金黄色葡萄球菌感染预防策略的有效性和成本完成系统回顾和荟萃分析： a) 在所有入院患者中； b) 正在通过医疗保健系统过渡的患者； 2) 比较万古霉素与其他抗葡萄球菌抗生素治疗侵袭性金黄色葡萄球菌（MRSA 和 MSSA）感染的有效性； 3) 使用目标 1 和 2 中收集的组织级和患者级数据，创建决策模型来比较预防和治疗金黄色葡萄球菌感染的策略的有效性、成本和成本效益。 VHA 通过 VHA MRSA 预防计划投入了大量时间和资源来预防 MRSA 传播和感染。这项研究与 VHA 的使命是一致的，即试图确定 VHA MRSA 预防计划可以实施的最有效和最具成本效益的策略，以预防和治疗金黄色葡萄球菌（包括 MRSA）感染。从而防止我国退伍军人中金黄色葡萄球菌相关的发病率和死亡率。本研究将利用荟萃分析、大型 VA 回顾性队列研究和数学模型来评估最有效和最具成本效益的策略，以减少与金黄色葡萄球菌相关的传播、感染和死亡率。这些数据对于预防和治疗金黄色葡萄球菌侵袭性感染至关重要。

项目成果

Comparative Effectiveness of Switching to Daptomycin Versus Remaining on Vancomycin Among Patients With Methicillin-resistant Staphylococcus aureus (MRSA) Bloodstream Infections.

耐甲氧西林金黄色葡萄球菌 (MRSA) 血流感染患者转用达托霉素与保留万古霉素的疗效比较。

• 发表时间: 2021
• 作者: Schweizer, Marin L;Richardson, Kelly;Vaughan Sarrazin, Mary S;Goto, Michihiko;Livorsi, Daniel J;Nair, Rajeshwari;Alexander, Bruce;Beck, Brice F;Jones, Michael P;Puig;Suh, Daniel;Ohl, Madeline;Perencevich, Eli N
• 通讯作者: Perencevich, Eli N