Hospital-Acquired Infections in the Elderly

描述（由申请人提供）：本奖项申请的总体目的是支持以患者为导向的研究计划和老年医院获得性感染的初级临床研究者的职业发展。长期目标：老年人（65岁以下）特别容易受到医院感染。尽管手术部位感染（SSI）和多重耐药细菌（MDRB）引起的感染具有显著的发病率，但研究人员对老年住院患者的这些感染的关注相对较少。这项应用的广泛目标是确定风险因素和干预措施，以改善住院老年人的预后。

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.