Epidemiology of MDRO Carriage in Nursing Homes

摘要 项目1：疗养院携带MDRO的流行病学和不良健康后果 多药耐药菌(MDRO)对人类健康构成严重而紧迫的威胁。虽然 广泛的努力已经开始扭转医院的趋势，护理方面的投资严重不足 MDRO患病率更高的家庭(NHS)(通常为65%，医院为10%)。NHS是独一无二的 由于逗留时间长，可能特别容易传播传染病的环境，请注意 医疗脆弱的居民，鼓励共享空间和活动，工作人员流动率高，以及有限 感染预防培训。由于用于筛查、监视和打击战略的资源稀缺 对于MDRO，需要证据来制定针对NHS的MDRO减少战略指南。 该项目将包括对临床的五个主要MDRO进行深入和同步的评估 对于每年在15,000家美国养老院接受护理的140万人来说，这具有重要意义。这些 MDRO包括三种根深蒂固在NHS中的地方性病原体，即耐甲氧西林 金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)和超广谱β-内酰胺酶 产内酰胺酶(ESBL)以及两种新出现的耐多药碳青霉烯类肠杆菌 (Cre)和金黄色念珠菌，这种耐药真菌能够导致大量的发病率和死亡率。这个 同时评估这些MDRO的目标是评估从筛选培养物中捕获的协同作用 并通知将一致针对MDRO的干预措施。 我们将利用涉及10,000多名NH的回顾和前瞻性研究相结合的方式 来自50个NHS的居民评估为MDRO采样身体部位和环境物体的有效方法 联运和联运。我们还将对居民、NH和社区进行全面评估- 单独和联合运输MDRO的风险因素水平。除了运输，我们将使用这些数据来 评估以后MDRO感染和住院的危险因素。重要的是，我们将专门评估 风险因素是否受种族、民族和社会经济地位的不同影响，以更好地阐明 保健提供或健康结果方面的差距。对携带和感染的主要驱动因素的了解将 告知NH干预措施的必要性和价值，以改变政策和实践。

Abstract Project 1: Epidemiology of MDRO Carriage and Adverse Health Outcomes in Nursing Homes Multidrug-resistant organisms (MDROs) are serious and urgent threats to human health. Although extensive efforts have begun to reverse the tide in hospitals, investments are severely lacking in nursing homes (NHs) where MDRO prevalence is much greater (routinely 65% vs. 10% in hospitals). NHs are unique settings that may be particularly prone to spreading contagion due to their long lengths-of-stay, care of medically vulnerable residents, encouragement of shared spaces and activities, high staff turnover, and limited infection prevention training. Due to scarce resources for screening, surveillance, and strategies to combat MDROs, evidence is needed to create guidelines for MDRO reduction strategies specific to NHs. This project will encompass an in-depth and simultaneous assessment of five major MDROs of clinical significance to the 1.4 million people who are cared for in 15,000 U.S. nursing homes each year. These MDROs include three endemic pathogens that are entrenched in NHs, namely methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and extended-spectrum beta- lactamase producers (ESBLs), as well as two emerging MDROs– carbapenem-resistant Enterobacterales (CRE), and Candida auris, an antibiotic-resistant fungus capable of substantial morbidity and mortality. The goal of the simultaneous assessment of these MDROs is to assess synergistic capture from screening cultures and inform interventions that would target MDROs in concert. We will capitalize on the combination of retrospective and prospective studies involving over 10,000 NH residents from 50 NHs to evaluate efficient ways to sample body sites and environmental objects for MDRO carriage and co-carriage. We also will perform comprehensive assessments of resident, NH, and community- level risk factors for carriage of MDROs, alone and in combination. Beyond carriage, we will use these data to assess risk factors for later MDRO infection and hospitalization. Importantly, we will specifically evaluate whether risk factors are differentially affected by race, ethnicity, and socioeconomic status to better elucidate NH disparities in care delivery or health outcomes. Knowledge of major drivers of carriage and infection will inform the need and value of NH interventions to transform policy and practice.