Antimicrobial Use and Control of Clostridium difficile transmission and infection

抗菌药物的使用以及艰难梭菌传播和感染的控制

• 批准号: 8280096
• 负责人: MICHAEL A. RUBIN
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-01-01 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8280096
• 关键词: Address; Affect; Antibiotics; Clostridium difficile; Complex; Computer Simulation; Containment; Cost-Benefit Analysis; Costs and Benefits; Data; Databases; Diarrhea; Disease Outbreaks; Effectiveness; Environment; Epidemic; Epidemiologic Methods; Epidemiologic Studies; Epidemiology; Evaluation; Exposure to; Future; Hand; Health Care Costs; Healthcare; Healthcare Systems; Hospitals; Hygiene; Incidence; Individual; Infection; Infection Control; Intervention; Knowledge; Length of Stay; Mediating; Methods; Mind; Modeling; Nosocomial Infections; Outcome; Patient Care; Patients; Pattern; Persons; Policies; Population; Process; Relative (related person); Research; Research Personnel; Risk; Risk Factors; Series; Services; System; Techniques; Time; Translational Research; Variant; Veterans; Work; advanced simulation; antimicrobial; antimicrobial drug; base; cost; design; factor C; high risk; improved; innovation; models and simulation; mortality; novel; pathogen; research study; response; simulation; tool; transmission process

DESCRIPTION (provided by applicant): Antibiotic prescribing in Clostridium difficile transmission and control Anticipated Impacts on Veteran's Health Care Our work will provide valuable information on the effectiveness and cost-benefit of different control policies for Clostridium difficile. By examining the associations between facility-level antibiotic prescribing and C. difficile infection (CDI) rates, and the impac and costs of various control strategies for CDI, we may gain a better understanding of the dynamics of C. difficile transmission in ways that will contribute to the implementation of VA-wide initiatives aimed at controlling CDI, such as antibiotic stewardship. The findings from this project have the potential to impact infection control practice throughout the VA healthcare system. Project Background C. difficile is the predominant infectious cause of healthcare-associated diarrhea and one of the most common types of healthcare-acquired infection, resulting in prolonged hospital stays, higher mortality, and increased healthcare costs. Exposure to antibiotics is the most important risk factor for CDI, presumably through the disruption of the normal fecal flora. Although a number of approaches have been proposed to contain outbreaks of CDI, such as improved hand hygiene and antibiotic stewardship, little is understood about how these interventions alter the dynamics of C. difficile transmission and acquisition and contribute to its control. Project Objectives C. difficile transmission is dependent on the interactions of innumerable factors and processes. The design of policies to control nosocomial CDI is aided by an understanding of these interactions and the relative impact of different control strategies on C. difficile transmission dynamics. With this in mind, our objectives are to (a) perform a facility-level analysis of associations between antibiotic use patterns and CDI rates at VA hospitals nationwide; (b) incorporate these patterns and associations into our agent-based simulation of nosocomial C. difficile transmission; (c) use the simulation to evaluate and compare alternative and novel policies for C. difficile control in VA hospitals, including antibiotc stewardship; and (d) explore the impact of these intervention strategies under varying conditions, including the introduction of an epidemic C. difficile strain. Methods We will refine and enhance a high-fidelity agent-based computer simulation of nosocomial C. difficile transmission created as part of a previous project. Our analyses of antibiotic prescribing and CDI rates will be based on a large, nationwide database of VA patient data that we have obtained from Patient Care Services. The combination of individual- and hospital-level data from more than 150 VA hospitals makes it feasible to fit models that separately estimate direct effects of antimicrobial agents on CDI risk from their indirect effects mediated through person-to-person spread. Hierarchical mixed effects models will be used to characterize the association of CDI rates to patient and hospital level factors. Results of these analyses will be incorporated into th simulation, which will then be used to assess the various strategies and factors that impact C. difficile transmission through a series of simulation experiments. Traditional quantitative epidemiologic methods will be used to analyze simulation results, with a focus on C. difficile incidence and transmission rates as outcomes. Dynamic cost-benefit analyses will also be performed by projecting C. difficile incidence rates and costs under the various alternative policy regimes.

描述（由申请人提供）： 艰难梭菌传播和控制中的抗生素处方对退伍军人医疗保健的预期影响我们的工作将为艰难梭菌不同控制政策的有效性和成本效益提供有价值的信息。通过检查设施级抗生素处方与艰难梭菌感染 (CDI) 率之间的关联，以及各种 CDI 控制策略的影响和成本，我们可以更好地了解艰难梭菌传播的动态，从而有助于实施旨在控制 CDI 的全退伍军人事务部举措，例如抗生素管理。该项目的研究结果有可能影响整个退伍军人管理局医疗系统的感染控制实践。项目背景 艰难梭菌是医疗保健相关性腹泻的主要感染原因，也是最常见的医疗保健获得性感染类型之一，会导致住院时间延长、死亡率升高和医疗费用增加。接触抗生素是 CDI 最重要的危险因素，可能是由于正常粪便菌群被破坏所致。尽管已经提出了许多方法来遏制 CDI 的爆发，例如改善手部卫生和抗生素管理，但人们对这些干预措施如何改变艰难梭菌传播和获取的动态并有助于其控制知之甚少。项目目标 艰难梭菌的传播取决于无数因素和过程的相互作用。了解这些相互作用以及不同控制策略对艰难梭菌传播动态的相对影响，有助于设计控制医院内 CDI 的政策。考虑到这一点，我们的目标是 (a) 对抗生素使用模式与 CDI 率之间的关联进行设施级分析 在全国退伍军人管理局医院； (b) 将这些模式和关联纳入我们基于代理的院内艰难梭菌传播模拟中； (c) 使用模拟来评估和比较退伍军人管理局医院中艰难梭菌控制的替代和新颖政策，包括抗生素管理； (d) 探讨这些干预策略在不同条件下的影响，包括引入流行性艰难梭菌菌株。方法我们将完善和增强基于代理的高保真计算机模拟，对院内艰难梭菌传播进行模拟，该模拟是先前项目的一部分。我们对抗生素处方和 CDI 率的分析将基于我们从患者护理服务获得的大型全国 VA 患者数据数据库。结合来自 150 多家 VA 医院的个人和医院层面的数据，可以拟合模型，分别估计抗菌药物对 CDI 风险的直接影响和通过人际传播介导的间接影响。分层混合效应模型将用于描述 CDI 率与患者和医院层面因素之间的关联。这些分析的结果将被纳入模拟中，然后通过一系列模拟实验来评估影响艰难​​梭菌传播的各种策略和因素。将使用传统的定量流行病学方法来分析模拟结果，重点关注艰难梭菌的发病率和传播率作为结果。还将通过预测各种替代政策下艰难梭菌的发病率和成本来进行动态成本效益分析 政权。