Genomics of MDRO Transmission in Nursing Homes

摘要 项目2：使用病原体基因组数据评估护理之家的MDRO传播模式 MDRO感染是疗养院（NH）居民发病和死亡的主要原因， 这些设施越来越被认为是MDRO向医院发展和传播的中心， 更广泛的社区。因此，迫切需要能够灵敏地检测、追踪和控制 MDRO在NH中的传播，以限制其对居民和医疗保健生态系统的影响。尽管如此 需要，MDRO动态在这种情况下的特点很差。携带MDRO的风险因素可能不 对应于MDRO传输的驱动器。高病原体流行率可能由以下因素推动：（i）外部 （ii）环境水库;或（iii）人与人之间的传播，每一项都需要 减少病原体负担的独特措施。传播动力也可能不同 生物体之间的差异很大，因此某些干预措施可能对不同的生物体产生不同的影响。 MDRO。因此，迫切需要对NH中MDRO进行基因组监测，以补充携带研究 通过深入了解设施内传播的主要驱动因素，为了弥补这一差距，我们 将评估人类和环境病原体宿主在MDRO传播中的作用， 疗养院，以优化基因组监测的采样。我们将开发综合模型 利用从宿主和环境来源收集的前瞻性基因组和流行病学数据 在一个优化的多模式抽样框架内，评估卫生机构中MDRO的传播和持久性。 此外，我们还将使用宏基因组序列评估NH中的微生物共享模式 数据，以解决进一步的微生物传播网络。作为一个高度一体化的框架的一部分， P01项目和核心，这些研究将导致对MDRO传播模式的更全面的看法 使用病原体基因组数据，包括一个新的基因组评估分析框架， 地方病病原体传播这项工作将推进感染预防和控制战略， 追踪和消除高风险传播途径，从而减轻国家卫生机构MDRO的负担， 医疗机构和社区。

Abstract Project 2: Evaluating MDRO Transmission Patterns in Nursing Homes Using Pathogen Genomic Data MDRO infections are a major cause of morbidity and mortality for residents in nursing homes (NHs), and these facilities are increasingly recognized as hubs for the rise and spread of MDROs into hospitals and the wider community. Thus, there is an urgent need to be able to sensitively detect, trace and control transmission of MDROs in NHs to limit their impact on residents and the healthcare ecosystem. Despite this need, MDRO dynamics are poorly characterized in this setting. Risk factors for MDRO carriage may not correspond to drivers of MDRO transmission. High pathogen prevalence may be fueled by (i) external importation with admission; (ii) environmental reservoirs; or (iii) inter-person transmission, each requiring distinct measures to reduce pathogen burden. It is also likely that transmission dynamics will differ considerably between organisms, and thus certain interventions may have a differential impact on distinct MDROs. Genomic surveillance of MDROs in NHs is thus urgently needed to complement studies of carriage and prevalence by providing insight into the major drivers of spread within facilities. To address this gap, we will assess the roles of human and environmental pathogen reservoirs contributing to MDRO transmission in nursing homes in order to optimize sampling for genomic surveillance. We will develop integrative models leveraging prospective genomic and epidemiological data from host and environmental sources collected within an optimized multi-modal sampling framework to assess the spread and persistence of MDROs in NHs. Furthermore, we will evaluate commensal organism sharing patterns in NHs using metagenomic sequence data to resolve further microbial transmission networks. As part of a highly integrated framework with the other P01 Projects and Cores, these studies will lead to a more comprehensive view of MDRO transmission patterns in NHs using pathogen genomic data, including a new analytical framework for genomic assessment of endemic pathogen transmission. This work will advance infection prevention and control strategies to detect, trace and eliminate high risk transmission pathways, thus reducing the burden of MDROs in NHs, connected healthcare facilities and the community.