Applied Research on Antimicrobial Resistance (AR)

抗菌素耐药性（AR）的应用研究

• 批准号: 6946923
• 负责人: RUTH LYNFIELD
• 金额: $ 22.71万
• 依托单位: MINNESOTA STATE DEPT OF HEALTH
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6946923
• 关键词: Staphylococcus aureus; antibiotics; antiinfective agents; bacteria infection mechanism; clinical research; data collection; disease /disorder prevention /control; drug resistance; health care cost /financing; health care model; health care service utilization; health services research tag; human subject; interview; mathematical model; methicillin; method development; model design /development; patient /disease registry; patient oriented research; statistics /biometry; virulence

Description (provided by applicant): Anti-microbial resistance among human bacterial pathogens is growing at an alarming rate and threatens the effectiveness of antibiotics. Resistant infections are associated with higher morbidity, mortality, and healthcare costs than infection with susceptible organisms. It is important to formulate a simple but robust method for estimating the cost of resistance that can be used by policy makers at all levels of the healthcare system. This proposal uses utilization rather than cost as our main outcome measure for estimation, inference, and guiding cost model development. Utilization reflects care actually rendered and provides common ground for cost estimation by users with different concepts of cost. We plan to construct a utilization profile comprised of individual elements such as length-of-stay ant procedures. We will also collect indirect costs, such as days lost from work, through case interviews. Because Staphylococcus aureus (SA) is one of the most important bacterial causes of human infectious disease morbidity and mortality and is a classic example of the successful adaptation of a pathogen to widespread antibiotic use, we will develop our model using SA infections. In order to make the model generalizable, it is necessary to have a complete picture of SA disease and not limit it to adult inpatient infection. We will study healthcare; and community-associated SA disease encompassing invasive and non-invasive cases. We will use prospective and retrospective data from heterogeneous sources and capitalize on our ongoing surveillance systems. Differences in utilization profiles of resistant and susceptible SA will be analyzed using multivariate statistical analysis due to expected high correlations among utilization components. This will make the method more sensitive to detection and estimation of differences. The results of statistical analysis will be used to inform the development and selection of a single "best" cost model that will be implemented in a spreadsheet tool. This tool can be adapted to the perspectives of different decision makers including healthcare providers, healthplan and hospital administrators, government, and others. The output of the cost model will feed the input of a more general societal economic model that will incorporate community transmission and costs associated with spread of MRSA to others in the community. This is the first time a society-wide estimate of the cost of resistance has been attempted.

描述（由申请人提供）：人类细菌病原体的抗微生物耐药性正在以惊人的速度增长，并威胁着抗生素的有效性。与易感微生物感染相比，耐药性感染的发病率、死亡率和医疗费用更高。制定一种简单但可靠的方法来估计耐药成本非常重要，该方法可供医疗系统各级决策者使用。该提案使用利用率而不是成本作为我们估计、推理和指导成本模型开发的主要结果衡量标准。利用率反映了实际提供的护理，并为具有不同成本概念的用户进行成本估算提供了共同点。我们计划构建一个由各个元素（例如停留时间蚂蚁程序）组成的利用率概况。我们还将通过案例访谈收集间接成本，例如误工天数。由于金黄色葡萄球菌 (SA) 是导致人类传染病发病和死亡的最重要的细菌原因之一，并且是病原体成功适应抗生素广泛使用的典型例子，因此我们将使用 SA 感染开发我们的模型。为了使模型具有普适性，需要对 SA 疾病有一个完整的了解，而不仅仅局限于成人住院患者感染。我们将学习医疗保健；和社区相关的 SA 疾病，包括侵入性和非侵入性病例。我们将使用来自不同来源的前瞻性和回顾性数据，并利用我们持续的监测系统。由于预期利用成分之间存在高度相关性，因此将使用多变量统计分析来分析耐药性和易感性 SA 的利用概况的差异。这将使该方法对差异的检测和估计更加敏感。统计分析的结果将用于指导开发和选择将在电子表格工具中实施的单一“最佳”成本模型。该工具可以适应不同决策者的观点，包括医疗保健提供者、健康计划和医院管理人员、政府等。成本模型的输出将作为更一般的社会经济模型的输入，该模型将纳入社区传播以及与 MRSA 向社区中其他人传播相关的成本。这是第一次尝试对全社会的抵抗成本进行估计。