Endemic and Emerging Multidrug Resistant Organisms in Nursing Homes: A Neglected Clinical Setting

疗养院中流行和新兴的多重耐药微生物：一个被忽视的临床环境

• 批准号: 10537752
• 负责人: Gabrielle Gussin
• 金额: $ 4.19万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-27 至 2025-06-26
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10537752
• 关键词: Acute; Address; Adverse event; Affect; American; Antibiotic Resistance; Antibiotics; Bathing; Biometry; COVID-19 pandemic; California; Candida auris; Caring; Case Mixes; Characteristics; Clinical; Clinical Research; Communicable Diseases; County; Data; Devices; Disease Outbreaks; Doctor of Philosophy; Environment; Environmental Pollution; Epidemiology; Fellowship; Goals; Head; Health care facility; Healthcare; Home Nursing Care; Hospitals; Incontinence; Individual; Infection; Infection prevention; Infectious Disease Epidemiology; Intensive Care Units; Intervention; Investigation; Link; Long-Term Care; Measures; Mentors; Morbidity - disease rate; Nursing Homes; Oranges; Patients; Performance; Prevalence; Prevalence Study; Prevention; Prospective Studies; Public Health; Public Health Nursing; Quality of Care; Research; Research Training; Resources; Risk; Risk Factors; Sampling; Site; Sterile coverings; Surface; Systems Biology; Touch sensation; Training; Universities; Virulent; Work; adverse outcome; attributable mortality; career; comorbidity; drug resistant pathogen; epidemiology study; fungus; high risk; improved; infection risk; methicillin resistant Staphylococcus aureus; mortality; multi-drug resistant pathogen; multidisciplinary; neglect; novel; operation; pathogen; pathogenic fungus; patient population; population health; prevent; response; screening; skills; transmission process; wound

Project Summary/Abstract Individuals receiving care in nursing homes disproportionally experience adverse outcomes due to multidrug-resistant organisms. This investigation will focus on an endemic and virulent pathogen common to nursing homes – methicillin-resistant Staphylococcus aureus (MRSA), and a highly emerging antibiotic resistant fungus – Candida auris, both of which have been linked to substantial morbidity and mortality in U.S. nursing homes. While MRSA has been a major prevention target in hospitals, little has been done to address this pathogen in nursing homes despite the fact that nursing homes have a 3-fold higher MRSA prevalence than hospitals and MRSA carriers in nursing homes have a 40% risk of infection per year. Risk in nursing homes due to MRSA is now compounded by C. auris, which has been termed the “fungal MRSA” due to similar transmission characteristics, including a remarkable propensity to colonize the body and persist on surfaces for prolonged periods. C. auris has been associated with intractable outbreaks in nursing homes with high attributable mortality; 5-10% of known carriers develop invasive infections and 30- 60% of those with invasive infection die as a result. Thus, determining which nursing home residents are at greatest risk for MRSA and C. auris carriage is crucial for effective response and control. The overall goal of this proposal is to generate novel data on MRSA and C. auris carriage and contamination in nursing homes to inform interventions to control these important pathogens. The first objective is to identify nursing home facility characteristics and resident risk factors associated with MRSA and C. auris carriage. Results from this objective could target high-risk residents for screening and prevention activities. The second objective is to determine if high-contact care activities (e.g., dressing, bathing) for MRSA and C. auris carriers cause contamination of high-touch objects in their immediate environment. If so, focused post-activity cleaning could be important to reduce MRSA and C. auris contamination and mitigate spread. I (Gabrielle Gussin, MS) am pursuing a Ph.D. in Public Health at the University of California, Irvine. This F31 fellowship will enable me to bridge my previous Master’s training in Systems Biology with skills in epidemiology, clinical research, and population health. I will be mentored by a multidisciplinary team with expertise in clinical infectious diseases, epidemiology, multidrug-resistant organisms, public health, nursing home operations, and biostatistics to support my proposed aims and career goals.

项目摘要/摘要 在护士家中接受护理的个人由于 多种耐药的生物。这项投资将集中于一种常见的地方性和毒性的病原体 护士房屋 - 耐甲氧西林金黄色葡萄球菌（MRSA）和高度新兴的抗生素 抗真菌 - 念珠菌的Auris，两者都与美国的大量发病率和死亡率有关 疗养院。虽然MRSA一直是医院的主要预防目标，但几乎没有采取任何措施来解决 护士之家目的地的这种病原体，护士房屋的MRSA患病率高3倍 比医院和护士房屋中的MRSA承运人每年感染的风险40％。 现在，由于MRSA而导致的护士房屋的风险现已被C. auris复杂化，这被称为 由于类似的传输特征，“真菌MRSA”，包括殖民的非凡承诺 身体并持续在表面上长时间。 C. Auris与棘手的暴发有关 具有高归因死亡率的护士房屋； 5-10％的已知携带者发展出侵入性感染和30- 侵入性感染的患者中有60％死亡。这是确定哪些护士家庭居民在 MRSA和C. Auris载体的最大风险对于有效的响应和控制至关重要。 该提案的总体目标是生成有关MRSA和C. Auris载体以及 护士房屋中的污染，以告知干预措施以控制这些重要的病原体。第一个 目的是确定护士房屋设施的特征和与MRSA和MRSA相关的居民风险因素 C. Auris载体。该目标的结果可能针对高风险居民进行筛查和预防 活动。第二个目标是确定MRSA的高接触护理活动（例如，敷料，沐浴）是否 和C. auris载体在其周围环境中会污染高点式物体。如果是这样，请集中精力 运动后清洁对于减少MRSA和C. ouris污染和减轻扩散可能很重要。 我（加布里埃尔·古辛（Gabrielle Gussin），女士）正在攻读博士学位。尔湾分校的公共卫生。这 F31奖学金将使我能够弥合我以前的硕士在系统生物学方面的培训，具体技能 流行病学，临床研究和人口健康。我将由一个多学科团队来考虑 临床传染病，流行病学，多药耐药的生物，公共卫生，护士方面的专业知识 家庭作业和生物统计学，以支持我提出的目标和职业目标。