Antibiotic use and bacteriuria in the rural nursing home

农村疗养院抗生素使用与菌尿情况

• 批准号: 7279320
• 负责人: MICHAEL A. RUBIN
• 金额: $ 13.47万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-15 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7279320
• 关键词: Antibiotic; use; bacteriuria; rural; nursing

DESCRIPTION (provided by the applicant): The goal of this proposal is to improve the care and safety of residents of nursing homes (NHs) in rural areas of Utah by addressing the growing problem of antibiotic resistance and inappropriate antibiotic use in this setting. Antibiotics are heavily used in nursing homes, and the selection pressure exerted by this level of antibiotic use, particularly in a contained environment, is enormous. Not surprisingly, antibiotic resistance in NHs and the risk of infection with an antibiotic-resistant organism are rising. This is of particular concern in a clinical setting where elderly residents already have a significantly increased risk of infection. The focus of this work will be antibiotic resistance among gram-negative urinary isolates and the management of catheter-associated bacteriuria and urinary tract infections (UTI) in the rural NH setting. It is hypothesized that the problems of antibiotic resistance and inappropriate antibiotic use are considerable in rural NHs, where little is known about management practices and surveillance is rarely, if at all, performed. These hypotheses will be investigated by two approaches. The first will employ a personal digital assistant (PDA)-based surveillance tool at NHs throughout rural Utah to track antimicrobial resistance among gram-negative urinary isolates, particularly those from long-term catheterized patients. The second will use a similar PDA-based tool to prospectively assess management of bacteriuria and UTI in long-term catheterized patients from rural Utah NHs. These studies will lay the groundwork for a third project, where the candidate will implement an intervention using a PDA-based decision-support tool to improve the management of catheter-associated asymptomatic bacteriuria and symptomatic urinary tract infection for residents of rural SNFs, emphasizing its impact on patient care, patient safety, and overall costs. This project is an ideal blend of observational and interventional epidemiology with the tools and techniques of medical informatics, applying them to the enormous clinical problem of antibiotic use and resistance in the NH setting. The NIH-funded K30 program at the University of Utah, along with the outstanding mentorship and research group assembled, will provide a superb educational and research environment for the mastering of these techniques as well as for maximizing the potential of this project and this candidate.

描述（由申请人提供）：该提案的目标是通过解决犹他州农村地区疗养院 (NH) 中日益严重的抗生素耐药性和抗生素使用不当问题，改善该地区疗养院 (NH) 居民的护理和安全。疗养院大量使用抗生素，这种水平的抗生素使用所带来的选择压力，特别是在封闭的环境中，是巨大的。毫不奇怪，NH 中的抗生素耐药性和感染抗生素耐药微生物的风险正在上升。在老年居民的感染风险已经显着增加的临床环境中，这一点尤其值得关注。 这项工作的重点是新罕布什尔州农村地区革兰氏阴性尿分离株的抗生素耐药性以及导管相关菌尿和尿路感染 (UTI) 的治疗。据推测，农村卫生机构的抗生素耐药性和抗生素使用不当问题相当严重，这些地方对管理实践知之甚少，而且很少进行监测（如果有的话）。这些假设将通过两种方法进行研究。第一个项目将在犹他州农村地区的 NH 中使用基于个人数字助理 (PDA) 的监测工具，以追踪革兰氏阴性尿液分离株的抗菌药物耐药性，特别是那些来自长期插管患者的细菌耐药性。第二个项目将使用类似的基于 PDA 的工具来前瞻性评估来自犹他州农村地区 NH 的长期插管患者的菌尿和尿路感染管理。这些研究将为第三个项目奠定基础，候选人将使用基于 PDA 的决策支持工具实施干预措施，以改善农村 SNF 居民对导管相关的无症状菌尿和有症状尿路感染的管理，强调其对患者护理、患者安全和总体成本的影响。 该项目是观察性和介入性流行病学与医学信息学工具和技术的理想结合，将其应用于NH环境中抗生素使用和耐药性的巨大临床问题。由 NIH 资助的犹他大学 K30 项目以及优秀的指导和研究小组将为掌握这些技术以及最大限度地发挥该项目和该候选人的潜力提供一流的教育和研究环境。