Transplant Associated Infection Surveillance Network

描述(申请人提供)：移植后感染是实体器官移植受者和造血干细胞移植受者发病率和死亡率的主要原因。在过去的3年里，我们参与了一个前瞻性的25中心监测网络(Transnet)，对18,000多名移植受者进行了筛查，并确定了1,200多例已证实和可能的侵袭性真菌感染(IFI)病例。这些数据提高了对美国疾病负担的了解，并突出了移植组之间的一些主要差异。该小组对重要风险因素进行病例对照试验的能力有限。美国疾病控制与预防中心发起的“器官移植感染检测和预防计划”是及时和必要的下一步，目的是评估与IFI发展相关的风险因素，并启动对重要非真菌病原体的前瞻性监测。我们建议实现以下目标：1)在3个美国移植中心(UAB、密歇根大学和宾夕法尼亚大学)的OTRs和HSCRR中进行前瞻性监测，以确定已证实的和可能的IFI，并开发可输出的监测方法；2)在侵袭性霉菌感染的高危患者中进行病例对照研究，以确定重要的医院和门诊风险因素，并建立预防建议；3)开发对选定的非真菌病原体(即西尼罗河病毒、呼吸道病毒和选定的多重耐药细菌)进行前瞻性监测的方法；以及4)建立真菌和临床标本资料库。这些目标的实现将为了解与发展国际金融机构有关的关键的可改变的风险因素提供极为重要的见解。此外，在多个地点建立标准监测方法将大大提高重要病原体数据收集的质量和便利性。最后，建立一家银行对于开发和验证新的诊断化验方法将是无价的。

Description (provided by applicant): Infections in the post-transplant period are a leading cause of morbidity and mortality among solid organ transplant recipients and hematopoietic stem cell transplant recipient. In the last 3 years we have been involved in a prospective 25 center surveillance network (TRANSNET), screening over 18,000 transplant recipients and identifying over 1,200 proven and probable cases of invasive fungal infection (IFI). This data has led to improved understanding of the disease burden in the U.S. and has highlighted some of the major differences among transplant groups. The group has had limited ability to perform case-control trials of Important risk factors. The CDC-sponsored initiative "Organ Transplant Infection Detection and Prevention Program" is a timely and necessary next step toward the assessment of risk factors associated with the Development of IFIs, and to initiate prospective surveillance for important non-fungal pathogens. We propose to achieve the following aims:1) to perform prospective surveillance among OTRs and HSCTRs for proven and probable IFIs at 3 US transplant centers (UAB, University of Michigan, and University of Pennsylvania), and to develop exportable surveillance methodology;2) to perform case-control studies among patients at high risk for invasive mould infections to identify significant nosocomial and outpatient risk factors and to establish recommendations for prevention;3) to develop methodologies for conducting prospective surveillance for selected non-fungal pathogens (i.e. West Nile virus, respiratory viruses, and selected multiresistant bacteria); and 4) to establish a bank for fungi and clinical specimens. The achievement of these goals will provide critically important insights into the key modifiable risk factors associated with the development of IFIs. Moreover, the establishment of standard surveillance methodology across multiple sites will significantly improve the quality and ease of data collection for important pathogens. Finally, the establishment of a bank will be invaluable in the development and validation of newer diagnostic assays.