The INFECTADO study: INFECTions Acquired by persons on maintenance hemoDialysis during hOspitalizations

INFECTADO 研究：住院期间接受维持性血液透析的人获得的感染

• 批准号: 10731626
• 负责人: ERIKA M D'AGATA
• 金额: $ 50万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10731626
• 关键词: INFECTADO; study; INFECTions; Acquired; persons

ABSTRACT More than 500,000 persons require maintenance hemodialysis (pMHD) per year in the United States, disproportionately affecting persons who are Black or Hispanic. pMHD are an Agency of Healthcare Research and Quality priority population. Infections are the second most common cause of mortality among pMHD due to a uremia-induced immunocompromised state and multiple co-morbidities. pMHD are also at substantial risk of hospital-acquired infections (HAI) as they are admitted to the hospital on average twice per year. Compared to the general hospitalized population, pMHD have a 2.4-fold higher risk of developing an HAI. There is a tremendous paucity of data pertaining to the epidemiology of HAI among pMHD, including potential racial and ethnic disparities. In this proposal, entitled “The INFECTADO study: INFECTions Acquired by persons on maintenance hemoDialysis during hOspitalizations”, we will quantify and characterize the epidemiology of HAI among pMHD. This proposal will therefore generate important information as how to best improve current prevention strategies aimed at reducing HAI in pMHD. Under aims 1 and 2, we will use the Unites States Renal Data System (USRDS), a nationwide-Medicare database, to analyze prevalence, risk factors and outcomes of HAI over an 8-year study period (~360,000 pMHD per year). Analyses will also focus on MHD modality type, race/ethnicity and social determinants of health. Under aim 3, we will use the Centers for Disease Control and Prevention’s National Healthcare Safety Network-based active surveillance data from 31 hospitals within the University of Pittsburgh Medical Center hospital network over an 8-year period (~4,777 pMHD per year), to further characterize HAI epidemiology, including causative pathogens and antimicrobial resistance profiles. By using two different data sources, a complete characterization of HAI epidemiology among pMHD will be obtained, since each data source provides supplementary data, as outlined in the proposal. The interdisciplinary team is comprised of investigators who have produced an abundance of scholarly end-stage renal disease research efforts over the last 2-decades and have expertise in infections among pMHD, data analyses using the USRDS and HAI active surveillance methodologies. A summary of specific aims are 1] Aims 1 and 2: To quantify and characterize HAI prevalence, risk factors and outcomes among all pMHD with and without HAI, and between: a] in-center vs home MHD, b] Black persons vs persons of other races on MHD and c] Hispanic vs non-Hispanic persons on MHD, using the USRDS database and 2] Aim 3: To quantify and characterize HAI epidemiology among pMHD with an HAI compared to hospitalized persons with an HAI, including causative pathogens and antimicrobial resistance profiles, using active infection surveillance. This proposal will result in an increased understanding of HAI epidemiology among the high-risk group of pMHD and health disparities within this population, and will provide important information to guide future prevention strategies aimed at reducing HAI and improving patient outcomes.

抽象的 在美国，超过500,000人每年需要维持血液透析（PMHD）， 不成比例地影响黑人或西班牙裔人。 PMHD是医疗保健研究机构 和质量优先人口。感染是由于 乳房诱导的免疫功能低下的状态和多种合并症。 PMHD也有很大的风险 医院可获得的感染（HAI）每年平均两次入院。相比 PMHD医院的一般人口，患有HAI的风险高2.4倍。有一个 PMHD中HAI的流行病学的数据非常匮乏，包括潜在的种族和 种族差异。在此提案中，名为“ Infectado研究：由人获得的感染 在住院期间维持血液透析”，我们将量化和表征HAI的流行病学 在PMHD中。因此，该提案将产生重要信息，作为如何最佳改善当前 预防策略旨在减少PMHD中的HAI。在目标1和2下，我们将使用统一州肾脏 数据系统（USRDS）是一个全国范围内的医疗数据库，用于分析患病率，风险因素和结果 HAI在8年的研究期内（每年约360,000 PMHD）。分析还将重点关注MHD模态类型， 种族/种族和健康的社会决定者。在AIM 3下，我们将使用中心进行疾病控制和 预防基于国家医疗保健网络的基于国家医疗保健网络的主动监视数据来自31家医院 匹兹堡大学医学中心医院网络在8年期间（​​每年约4,777 PMHD）， HAI流行病学的进一步表征，包括天主教和抗菌素耐药性。经过 使用两个不同的数据源，将获得PMHD之间HAI流行病学的完整表征， 由于每个数据源提供了补充数据，如提案中所述。跨学科团队是 完成了研究的研究人员，这些研究人员已经产生了科学的终末期肾脏疾病研究 在过去的两个十年中的努力，并在PMHD之间具有专业知识，使用USRDS进行数据分析 和HAI主动监视方法。特定目的的摘要是1]目标1和2：量化和 表征HAI患病率，风险因素和与HAI的所有PMHD之间的特征，以及：A] 中心与家庭MHD，B]黑人与MHD和C]西班牙裔与非西班牙裔的其他种族的人 MHD上的人员，使用USRDS数据库和2] AIM 3：量化和表征HAI流行病学 与HAI的PMHD与HAI相比 使用主动感染监测，抗菌素抗性谱。该建议将导致增加 了解HAI高危PMHD和健康差异之间的HAI流行病学 人口，并将提供重要的信息，以指导旨在减少HAI的未来预防策略 并改善患者预后。