Etiology, Epidemiology, and Clinical Outcomes of Health Care Associated Pneumonia

医疗保健相关肺炎的病因学、流行病学和临床结果

• 批准号: 7532576
• 负责人: Karl J. Madaras-Kelly
• 金额: $ 6.2万
• 依托单位: IDAHO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-06-19 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7532576
• 关键词: Adherence; Alternative Therapies; American; Americas; Antibiotic Resistance; Antibiotic Therapy; Antibiotics; Bacteria; Cephalosporins; Chest; Clinical; Cohort Studies; Communicable Diseases; Communities; Data; Diagnosis; Equation; Etiology; Exposure to; Fluoroquinolones; Future; Generations; Guidelines; Health Personnel; Healthcare; Healthcare Systems; Infection; Inpatients; Logistic Regressions; Macrolides; Medical center; Modeling; Mono-S; Multi-Drug Resistance; Other Therapy; Outcome; Patients; Performance; Pneumonia; Probability; Process; Pseudomonas; Pseudomonas aeruginosa; Public Health; Publishing; Purpose; Recommendation; Refit; Reporting; Research; Research Personnel; Resources; Respiratory System; Risk; Risk Factors; Score; Selection Bias; Societies; Sputum; Standards of Weights and Measures; Survival Rate; Thinking; Treatment Protocols; Veterans; Work; bacterial resistance; base; clinical epidemiology; cohort; day; drug resistant bacteria; health care model; improved; methicillin resistant Staphylococcus aureus; pathogen; predictive modeling

DESCRIPTION (provided by investigator): The American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) have periodically published guidelines on the diagnosis and management of pneumonia. In 2005, the ATS/IDSA published guidelines which define a new subset of pneumonia entitled Health Care Associated Pneumonia (HCAP). HCAP pertains to patients that have frequently interacted with the Health Care system prior to pneumonia, which is thought to increase risk for infections caused by multiple drug-resistant (MDR) bacteria. The guidelines recommend aggressive diagnosis and antibiotic treatment regimens for HCAP. Research specific to HCAP is limited and the guideline recommendations have been questioned. Proposal Aims include: 1) to compare clinical outcome of patients with HCAP that receive standard community acquired pneumonia (CAP) therapy to those that receive alternative therapy such as guideline similar therapy (GTS)]; 2) identify risk factors for MDR bacteria including Methicillin-Resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, compared to non-MDR bacteria and develop models that accurately identify patients infected with MDR. This will be a multi- center retrospective cohort study of Veterans Affairs Medical Center inpatients with HCAP. Propensity score matching will be used to adjust for potential confounding and selection bias associated with non-random treatment allocation. Generalized estimating equations will be used to characterize associations between 30-day survival and treatments: standard CAP; anti-MRSA and anti-Pseudomonas or GST, anti-MRSA, anti-Pseudomonas, or other therapies. In Aim 2 MDR status will be determined for all subjects. Logistic regression will be used to develop descriptive models of MDR risk based on non-HCAP specific risk criteria reported in the guidelines as well as HCAP specific data from the cohort. The process will be repeated for specific MDR pathogens: MRSA and Pseudomonas aeruginosa. The best model of MDR status will be refitted with MRSA and Pseudomonas aeruginosa data and compared to pathogen- specific derived models. The proposed study will determine whether adherence to HCAP guideline recommended treatments improve survival. Further developing specific prediction rules for MDR pathogens will refine future empirical HCAP antibiotic selection. Finally, determining which patients may benefit most from empirical MDR directed antibiotic therapy may help to limit antibiotic resistance. R&R: Other Project Materials 7. PUBLIC HEALTH RELEVANCE Patients with exposure to the Health Care system resources are at increased risk for infections caused by antibiotic resistant bacteria. The purpose of this study is to determine how frequently antibiotic resistant bacteria cause Health Care Associated pneumonia, what type of Health Care exposures are related to developing a pneumonia due to resistant bacteria, and what antibiotic treatment combinations work the best for Health Care Associated pneumonia. This study will improve public health by helping health care providers choose the right antibiotics when treating Health Care Associated pneumonia and not using more antibiotics than necessary.

描述（由研究者提供）：美国胸科学会（ATS）和美国传染病学会（IDSA）定期发布肺炎诊断和管理指南。2005年，ATS/IDSA发布了一个新的指南，定义了一个新的肺炎子集，称为卫生保健相关性肺炎（HCAP）。HCAP涉及在肺炎之前经常与医疗保健系统相互作用的患者，这被认为会增加由多重耐药（MDR）细菌引起的感染风险。该指南建议对HCAP进行积极的诊断和抗生素治疗方案。针对HCAP的研究有限，指南建议受到质疑。提案目标包括：1）比较接受标准社区获得性肺炎（CAP）治疗的HCAP患者与接受替代治疗（如指南相似治疗（GTS））的HCAP患者的临床结局; 2）与非MDR细菌相比，识别MDR细菌（包括耐甲氧西林金黄色葡萄球菌（MRSA）和铜绿假单胞菌）的风险因素，并开发准确识别MDR感染患者的模型。这将是一个多中心的回顾性队列研究退伍军人事务医疗中心住院患者的HCAP。将使用倾向评分匹配来调整与非随机治疗分配相关的潜在混杂和选择偏倚。将使用广义估计方程描述30天生存期与治疗之间的相关性：标准CAP;抗MRSA和抗假单胞菌或GST、抗MRSA、抗假单胞菌或其他治疗。在目标2中，将确定所有受试者的MDR状态。基于指南中报告的非HCAP特异性风险标准以及队列中的HCAP特异性数据，将使用逻辑回归开发MDR风险的描述性模型。将对特定MDR病原体（MRSA和铜绿假单胞菌）重复该过程。MDR状态的最佳模型将用MRSA和铜绿假单胞菌数据重新拟合，并与病原体特异性衍生模型进行比较。这项拟议的研究将确定是否坚持HCAP指南推荐的治疗方法可以提高生存率。进一步开发MDR病原体的特定预测规则将完善未来的经验性HCAP抗生素选择。最后，确定哪些患者可能从经验MDR导向的抗生素治疗中获益最多，可能有助于限制抗生素耐药性。R&R：其他项目材料7.公共卫生相关性暴露于卫生保健系统资源的患者感染抗生素耐药菌的风险增加。本研究的目的是确定抗生素耐药细菌导致卫生保健相关性肺炎的频率，何种类型的卫生保健暴露与耐药细菌引起的肺炎有关，以及何种抗生素治疗组合对卫生保健相关性肺炎最有效。这项研究将通过帮助卫生保健提供者在治疗卫生保健相关性肺炎时选择正确的抗生素，而不是使用超过必要的抗生素来改善公共卫生。