Using Big-Data to Identify & Prevent Transmission of Carbapenem-Resistant Enterobacteriaceae within VHA

利用大数据进行识别

• 批准号: 10595493
• 负责人: Andrew Chou
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10595493
• 关键词: Adverse event; Antibiotic Resistance; Antibiotic Therapy; Antibiotic-resistant organism; Antibiotics; Antimicrobial Resistance; Area; Awareness; Bacteria; Bacterial Antibiotic Resistance; Big Data; Big Data Methods; Bioinformatics; Biometry; Board Certification; Carbapenems; Categories; Ceftazidime; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical; Clinical Trials; Clostridium difficile; Combined Antibiotics; Combined Modality Therapy; Communicable Diseases; Complex; Dangerousness; Data; Data Science; Databases; Dedications; Disease Outbreaks; Doctor of Philosophy; Educational Status; Effectiveness; Enterobacter cloacae; Enterobacteriaceae Infections; Environment; Exclusion; Faculty; Formularies; Fostering; Future; Gram-Negative Bacteria; Guidelines; Health; Health Care Costs; Health care facility; Hospitalization; Hospitals; Individual; Infection; Infection prevention; Institution; Intervention; Junior Physician; K-Series Research Career Programs; Klebsiella pneumoniae; Knowledge; Lead; Master of Science; Mathematics; Measures; Medical center; Medicine; Mentors; Meropenem; Microbiology; Modeling; Morbidity - disease rate; Oncology; Outcome; Patients; Performance; Persons; Physicians; Pilot Projects; Population; Prevalence; Prevention; Prevention program; Productivity; Public Health; Publications; Publishing; Recording of previous events; Regimen; Reporting; Research; Research Personnel; Research Priority; Resistance; Risk; Risk Factors; Safety; Scientist; Sepsis; Specialist; Statistical Models; Systems Biology; Techniques; Testing; Training; Treatment outcome; United States; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Virulence Factors; Work; acute care; antibiotic resistant infections; carbapenem resistance; carbapenem-resistant Enterobacteriaceae; carbapenemase; career; clinical risk; college; combat; comorbidity; computer program; design; evidence base; experience; high risk; improved; innovation; microbial genomics; mid-career faculty; military veteran; mortality; multi-drug resistant pathogen; nephrotoxicity; novel; ototoxicity; post-doctoral training; predictive tools; prevent; prospective; resistant Klebsiella pneumoniae; risk stratification; screening; side effect; skills; statistics; success; surveillance strategy; tool; transmission process; virus related cancer

This proposal is designed to provide the necessary knowledge, skills, and experience required to facilitate the transition of Andrew Chou, MD, from junior to independent investigator in the field of antibiotic- resistant infections. Dr. Chou is a well-trained infectious diseases specialist with graduate-level education and postdoctoral training in microbiology and microbial genomics. He has been studying multidrug-resistant organisms (MDRO) since 2009 and has a demonstrated history of dedication to a career in research and to the Veterans Health Administration (VHA). Dr. Chou has identified a mentoring committee consisting of senior investigators who have demonstrated success in mentoring junior investigators to independence. Barbara W. Trautner, MD, PhD, associate professor of Medicine (Infectious Diseases) and faculty at the Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) at the Houston VA and Baylor College of Medicine (BCM), will serve as the primary mentor. The co-mentors are: 1) Lynn Zechiedrich, PhD, an expert in mechanisms of antibiotic resistance and systems biology; 2) Elizabeth Chiao, MD, MPH, an expert in using large databases to study viral-associated malignancies and board-certified in both infectious diseases and oncology; 3) Richard Sucgang, PhD, an expert in bioinformatics of antibiotic resistance; and 4) Peter Richardson, PhD, an expert in mathematical statistics and probability modeling. Dr. Chou has a history of productivity with the primary mentor and multiple co-mentors, including publications in studying Klebsiella pneumoniae virulence factors within VHA, bloodstream infections due to gram-negative bacteria, and an outbreak of carbapenem-resistant Enterobacteriaceae (CRE). To expand his skill set, Dr. Chou will pursue a Master of Science in biostatistics, studying the data science track and biostatistics. Antibiotic resistance is an important health concern in the United States and within VHA. CRE is 1 of the most dangerous antibiotic-resistant organisms because nearly half of all patients with CRE bloodstream infections die. CRE infections are resistant to all or nearly all antibiotics, often are treated with last-line antibiotics that are associated with severe side-effects, and can lead to hospital outbreaks. CRE infections incur significant morbidity and mortality, yet optimal prevention and treatment of CRE are unknown. The published report, Establishing the Research Agenda for Preventing Transmission of MDRO in Acute-Care Settings in VHA, identified studying screening strategies to identify Veterans asymptomatically colonized with CRE as a research priority. Determining the optimum treatment of CRE is challenging because patients with CRE infections often have complex comorbidities that exclude them from clinical trials. The project objective is to combat CRE within VHA by (1) developing novel, targeted surveillance strategies that identify Veterans at high risk for CRE colonization; and (2) identifying which antibiotic regimens are associated with the most desirable clinical outcomes (ie, clinical cure without adverse events) in Veterans with CRE infections. Aim 1 will create the VHA CRE colonization risk-stratification tool for the national VHA population using bioinformatics to analyze large-scale clinical VHA databases. Aim 2 will develop best practices for treatment of CRE bloodstream infection by applying biostatistical techniques to VHA databases to compare newer antibiotics to standard therapy, monotherapy vs. combination antibiotic therapy, and short- course vs. prolonged-course duration of antibiotic therapy. Aim 3 will be to conduct a pilot intervention of 3 different CRE surveillance strategies: passive surveillance, surveillance targeted by clinical risk factors, and surveillance targeted to patients with Clostridioides difficile infection. The environment at BCM is ideal for fostering the training of junior physician investigators. Dr. Chou will benefit from strong institutional support, outstanding mentoring, and a clear path to independence.

该提案旨在提供必要的知识、技能和经验 促进安德鲁·周（Andrew Chou）医学博士从抗生素领域的初级研究员转变为独立研究员- 耐药感染。周博士是一位训练有素的传染病专家，拥有研究生学历和 微生物学和微生物基因组学博士后培训。他一直在研究多重耐药性 自 2009 年以来，一直致力于生物体（MDRO），并拥有致力于研究事业和 退伍军人健康管理局 (VHA)。周博士指定了一个由资深人士组成的指导委员会 在指导初级调查员独立方面取得成功的调查员。芭芭拉·W. Trautner，医学博士、哲学博士、医学副教授（传染病）和该中心的教员 休斯敦退伍军人管理局和贝勒医学院的质量、有效性和安全性创新 (IQuESt) （BCM），将担任主要导师。共同导师是： 1) Lynn Zechiedrich 博士，一位 抗生素耐药性机制和系统生物学； 2) Elizabeth Chiao，医学博士，公共卫生硕士，使用专家 用于研究病毒相关恶性肿瘤的大型数据库，并在传染病和传染病方面经过委员会认证 肿瘤学； 3）Richard Sucgang，博士，抗生素耐药性生物信息学专家； 4）彼得 理查森博士，数理统计和概率建模专家。周医生有以下病史： 主要导师和多个共同导师的生产力，包括研究克雷伯氏菌的出版物 VHA 内的肺炎链球菌毒力因子、革兰氏阴性菌引起的血流感染以及 耐碳青霉烯类肠杆菌科细菌（CRE）的爆发。为了扩展他的技能，周博士将追求 生物统计学理学硕士，研究数据科学轨道和生物统计学。 抗生素耐药性是美国和 VHA 内部的一个重要健康问题。商业地产是 1 最危险的抗生素抗药性微生物，因为近一半的 CRE 患者血液中存在 感染死亡。 CRE 感染对所有或几乎所有抗生素均具有耐药性，通常采用最后一线治疗 抗生素会带来严重的副作用，并可能导致医院爆发疫情。 CRE 感染会导致显着的发病率和死亡率，但 CRE 的最佳预防和治疗 未知。已发表的报告《制定预防多重耐药菌传播的研究议程》 在 VHA 的急性护理环境中，确定了研究筛查策略以识别无症状退伍军人 以 CRE 作为研究重点。确定 CRE 的最佳治疗方法具有挑战性，因为 CRE 感染患者通常有复杂的合并症，使他们无法参加临床试验。 该项目的目标是通过 (1) 开发新颖的、有针对性的监视来打击 VHA 内的 CRE 识别 CRE 定植高风险退伍军人的策略； (2) 确定哪些抗生素治疗方案 与退伍军人最理想的临床结果（即无不良事件的临床治愈）相关 患有 CRE 感染。目标 1 将为国家 VHA 创建 VHA CRE 定植风险分层工具 使用生物信息学分析大规模临床 VHA 数据库的人群。目标2将发展得最好 通过将生物统计技术应用于 VHA 数据库来治疗 CRE 血流感染的实践 将新型抗生素与标准疗法、单一疗法与联合抗生素疗法以及短期疗法进行比较 抗生素治疗的疗程与延长疗程。目标 3 将是进行 3 项试点干预 不同的 CRE 监测策略：被动监测、针对临床危险因素的监测，以及 针对艰难梭菌感染患者的监测。 BCM 的环境非常适合培养初级医师研究人员。周博士将 受益于强大的机构支持、出色的指导和清晰的独立之路。