Hospital-Acquired Infections in the Elderly

描述(由申请人提供)：该奖项申请的总体目的是支持以患者为中心的研究计划和老年医院获得性感染初学临床调查员的职业发展。长期目标：老年人(65岁)特别容易受到医院感染的影响。尽管外科手术部位感染(SSI)和多药耐药菌(MDRB)感染的发病率很高，但研究人员对老年住院患者中的这些感染关注相对较少。这项应用的广泛目标是确定风险因素和干预措施，以改善老年住院患者的预后。 具体目标：1)为老年人SSI和MDRB的发展建立风险模型，并检验关于特定危险因素的先前假设；以及2)量化SI和医院内MDRB对老年人健康结局的影响。将评估手术(SSI)和感染(MDRB)后90天内的健康结果(死亡率、住院时间和住院费用)。此外，还将评估SSI对ADL残疾的影响。 方法：该项目将利用10家研究医院和一个感染控制基础设施，其中包括3名内科流行病学家和20多名感染控制从业者。目前通过前瞻性监测确定了患有SSI和由于MDRB引起的医院感染和定居的患者，这些患者已经并将继续被前瞻性地输入研究医院的电子数据库。其他研究数据将从患者图表和医院数据库中获得。对于SSI的研究，将以患有SSI的老年患者为研究对象，并将其与没有SSI的老年手术患者进行比较。ADL功能障碍将在手术前通过复查图表进行评估，并在术后90天通过电话访谈进行评估。对于MDRB的研究，最初发生院内MDRB的老年患者将被作为病例进行研究，并将其与没有感染或因MDRB而定居的老年患者进行比较。在风险模型分析中，被MDRB定植或感染的患者将被作为病例；而在健康结果分析中，只有因MDRB感染的患者将被作为病例进行研究。为SSI和MDRB确定的风险因素以及SSI和MDRB对健康结果的影响将用于设计和实施未来的预防干预措施。

DESCRIPTION (provided by applicant): The overall purpose of this award application is to support the patient-oriented research program and career development of a beginning clinical investigator in hospital-acquired infections in the elderly. Long-term objective: Elderly (> 65 years old) adults are particularly vulnerable to nosocomial infections. Despite significant morbidity associated with surgical site infection (SSI) and infections caused by multi-drug resistant bacteria (MDRB), investigators have paid relatively little attention to these infections in elderly hospitalized patients. The broad objectives for this application are to identify risk factors and interventions to improve outcomes of elderly hospitalized persons. Specific aims: 1) Create risk models for the development of SSI and MDRB in the elderly and to test a prior hypotheses regarding particular risk factors; and 2) quantify the impact of SI and nosocomial MDRB on health outcomes in the elderly. Health outcomes (mortality, duration of hospitalization and hospital costs) will be assessed for the 90-day period following surgery (for SSI) and infection (for MDRB). In addition, the impact of SSI on ADL disability will also be assessed. Methods: The project will utilize 10 study hospitals and an infection control infrastructure that includes 3 physician epidemiologists and over 20 infection control practitioners. Patients with SSI and nosocomial infection and colonization due to MDRB are currently identified through prospective surveillance and have been and will continued to be prospectively entered into electronic databases at study hospitals. Additional study data will be obtained from patient charts and hospital databases. For the study of SSI, elderly patients with SSI will be studied as cases and will be compared to elderly operative patients without SSI. ADL disability will be assessed preoperatively through chart review and postoperatively by phone interview 90 days after surgery. For the study of MDRB, elderly patients with an initial episode of nosocomial MDRB will be studied as cases and will be compared to elderly patients without infection or colonization due to MDRB. For the risk model analysis, patients colonized or infected with MDRB will be included as cases; and for the health outcomes analysis, only patients with infections due to MDRB will be studied as cases. The risk factor identified for SSI and MDRB and the impact of SSI and MDRB on health outcomes will be used to design and implement future preventive interventions.