MRSA in Children: Epidemiology, Pathogenesis, and Prevention

儿童 MRSA：流行病学、发病机制和预防

• 批准号: 7638697
• 负责人: AARON M MILSTONE
• 金额: $ 13.43万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7638697
• 关键词: Admission activity; Adult; Advisory Committees; Antibiotic Resistance; Archives; Area; Award; Bacteria; Baltimore; Bathing; Biometry; Blood; Cessation of life; Child; Childhood; Chlorhexidine; Clinical; Clinical Data; Clinical Microbiology; Clinical Research; Clinical Trials; Cohort Studies; Communities; Critically ill children; Data; Development; Disease; Disease Outbreaks; Environment; Epidemic; Epidemiologic Studies; Epidemiology; Faculty; Financial cost; Funding; Future; Health Care Costs; Healthcare; Hospital Departments; Hospitalized Child; Hospitals; Incidence; Infection; Infection prevention; Intervention; Laboratories; Lead; Link; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; Multi-Drug Resistance; Nosocomial Infections; Pathogenesis; Pathogenicity; Patients; Pediatric Hospitals; Pediatric Intensive Care Units; Population; Prevalence; Prevention; Prevention strategy; Principal Investigator; Randomized Controlled Trials; Recurrence; Research; Research Personnel; Resource Allocation; Resources; Risk; Scientist; Septic Shock; Skin; Soft Tissue Infections; Stream; Surveillance Program; Testing; Time; Training; United States; Virulence; Virulent; base; career development; child well being; epidemiology study; experience; high risk; innovation; methicillin resistant Staphylococcus aureus; mortality; novel strategies; patient oriented research; patient safety; prevent; programs; prospective; research study; sound; transmission process; ward

DESCRIPTION (provided by applicant): This K23 award will provide Aaron Milstone, MD with the necessary resources and protected time to become an independent investigator performing patient-oriented research. In addition to the research studies, this proposal outlines a comprehensive career development program, including advanced coursework in epidemiology, biostatistics, and clinical trial methods and mentorship from a national leader in healthcare epidemiology in combination with a faculty advisory committee. The research component of this award will focus on methicillin-resistant Staphylococcus aureus (MRSA) in children with an emphasis on community-associated MRSA (CA-MRSA) strains. As CA-MRSA strains fuel an MRSA epidemic, the impact and control of MRSA requires further study. CA-MRSA strains are entering the hospital, being spread to children, and causing hospital-acquired infections and hospital outbreaks. The clinical spectrum of MRSA infection in children is well described. However, the epidemiology and impact of MRSA colonization and transmission in children is not well characterized. In addition, the virulence and transmissibility of CA-MRSA strains remains unclear. The pediatric intensive care unit (PICU) provides an environment amendable to studying the epidemiology, pathogenesis and prevention of MRSA. The proposed studies will 1) measure the prevalence of MRSA colonization and the incidence of MRSA transmission in a pediatric population and determine the distribution of various MRSA strains; 2) determine the risk of MRSA infection in children colonized with different MRSA strains; and 3) assess the efficacy of bathing patients daily with chlorhexidine as a feasible strategy to reduce MRSA transmission. These studies will utilize the resources of The Johns Hopkins Hospital Department of Hospital Epidemiology and the Clinical Microbiology Laboratory. We anticipate that these studies will serve as a model for assessing the impact of multidrug-resistant bacteria in a pediatric population, and help guide the allocation of resources towards infection prevention strategies in hospitalized children. Future studies will use the archive of bacterial isolates and their associated clinical data to further characterize the pathogenicity of various MRSA strains. RELEVANCE: MRSA is a significant cause of disease and death in the United States and around the world. Because studies in adults show increased financial costs and mortality associated with MRSA, the epidemiology and impact of MRSA in children requires further study. Sound epidemiologic investigation and innovative and feasible interventions are needed to control MRSA transmission and prevent MRSA disease.

描述（由申请人提供）：该K23奖将为医学博士Aaron Milstone提供必要的资源和受保护的时间，以成为一名独立的研究人员，从事以患者为导向的研究。除研究外，该提案还概述了一项全面的职业发展计划，包括流行病学，生物统计学和临床​​试验方法的高级课程以及医疗保健流行病学国家领导者的临床试验方法和指导，并与教师咨询委员会结合使用。该奖项的研究组成部分将集中于耐甲氧西林金黄色葡萄球菌（MRSA），重点是社区相关的MRSA（CA-MRSA）菌株。由于CA-MRSA菌株助长了MRSA流行，因此MRSA的影响和控制需要进一步研究。 CA-MRSA菌株正在进入医院，分为儿童，并引起医院获得的感染和医院暴发。很好地描述了儿童MRSA感染的临床光谱。但是，MRSA定殖和传播在儿童中的流行病学和影响尚未得到很好的特征。另外，CA-MRSA菌株的毒力和可传染性尚不清楚。小儿重症监护病房（PICU）为研究MRSA的流行病学，发病机理和预防提供了一种修正的环境。拟议的研究将1）衡量小儿种群中MRSA定殖的患病率和MRSA传播的发生率，并确定各种MRSA菌株的分布； 2）确定用不同MRSA菌株殖民的儿童中MRSA感染的风险； 3）评估每天用洗澡的患者作为减少MRSA传播的可行策略的疗效。这些研究将利用约翰·霍普金斯医院医院流行病学和临床微生物学实验室的资源。我们预计，这些研究将成为评估多药耐药细菌在小儿人群中的影响的模型，并有助于指导资源分配给住院儿童的感染预防策略。未来的研究将使用细菌分离株及其相关临床数据的存档来进一步表征各种MRSA菌株的致病性。相关性：MRSA是美国和世界各地造成疾病和死亡的重要原因。由于成人的研究表明与MRSA相关的财务成本和死亡率增加，因此MRSA在儿童中的流行病学和影响需要进一步研究。需要声音流行病学研究以及可行的和可行的干预措施，以控制MRSA传播并预防MRSA病。