Genomics of MDRO Transmission in Nursing Homes

摘要 项目2：使用病原体基因组数据评估疗养院的MDRO传播模式 MDRO感染是养老院(NHS)居民发病和死亡的主要原因， 这些设施越来越被认为是MDRO兴起和传播到医院和 更广泛的社区。因此，迫切需要能够灵敏地检测、跟踪和控制 在NHS中传播MDRO，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的动态在这种情况下表现得很差。MDRO运输的风险因素可能不会 对应MDRO变速器的驱动器。高病原体流行率可能是由(I)外部因素造成的 入境；(Ii)环境水库；或(Iii)人与人之间的传播，每一项都需要 采取不同的措施减少病原体负担。传输动态也可能会有所不同 相当大的有机体之间，因此某些干预可能对不同的 MDRO。因此，迫切需要对国民保健系统中的MDRO进行基因组监测，以补充对携带者的研究 通过提供对设施内传播的主要驱动因素的洞察，来提高传播速度和流行率。为了解决这一差距，我们 将评估导致MDRO传播的人类和环境病原体储备库在 疗养院，以优化基因组监测的采样。我们将开发综合模式 利用从宿主和环境来源收集的预期基因组和流行病学数据 在优化的多模式抽样框架内，评估MDRO在国民保健系统中的传播和持久性。 此外，我们将使用元基因组序列来评估NHS中的共生生物共享模式 数据，以解决进一步的微生物传播网络。作为与其他组件高度集成框架的一部分 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 在NHS中使用病原体基因组数据，包括用于基因组评估的新分析框架 地方性病原体传播。这项工作将推进感染预防和控制战略，以检测， 追踪和消除高风险的传播途径，从而减轻NHS中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.