Epidemiology of MDRO Carriage in Nursing Homes

摘要 项目1：疗养院中MDRO携带和不良健康结果的流行病学 多重耐药微生物（MDRO）是对人类健康的严重和紧迫的威胁。虽然 广泛的努力已经开始扭转医院的趋势，护理投资严重缺乏 MDRO患病率更高的家庭（NH）（通常为65%，医院为10%）。NH是独一无二的 由于长期逗留，护理人员可能特别容易传播传染病， 医疗弱势居民，鼓励共享空间和活动，员工流动率高， 感染预防培训。由于筛查、监视和打击战略的资源稀缺， MDRO，需要证据来制定针对NH的MDRO减少策略指南。 该项目将包括对临床的五个主要MDRO进行深入和同时的评估， 这对每年在15，000家美国养老院接受护理的140万人来说意义重大。这些 MDRO包括三种在NH中根深蒂固的地方性病原体，即耐甲氧西林 金黄色葡萄球菌（MRSA）、万古霉素耐药肠球菌（VRE）和超广谱β- 内酰胺酶生产者（ESBLs）以及两种新出现的MDRO-碳青霉烯类耐药肠球菌 (CRE)和耳念珠菌（Candida auris），其是一种能够引起显著发病率和死亡率的抗真菌药。的 同时评估这些MDRO的目的是评估筛选培养物的协同捕获 并为针对MDRO的干预措施提供信息。 我们将利用涉及10，000多名NH的回顾性和前瞻性研究的组合 来自50个国家卫生机构的居民评估为MDRO采样身体部位和环境物体的有效方法 运输和共同运输。我们还将对居民、NH和社区进行全面评估- 水平的风险因素的携带MDRO，单独和组合。除了运输，我们将使用这些数据来 评估以后MDRO感染和住院的风险因素。重要的是，我们将专门评估 风险因素是否受到种族、民族和社会经济地位的不同影响，以更好地阐明 NH在护理提供或健康结果方面的差异。了解主要的传播和感染因素， 告知国家卫生干预措施的必要性和价值，以改变政策和做法。

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.