TRANSMISSION DYNAMICS OF CA-MRSA AMONG HOUSEHOLD MEMBERS AND THE HOME ENVIRONMENT

CA-MRSA 在家庭成员和家庭环境中的传播动态

• 批准号: 8282706
• 负责人: Stephanie Ann Fritz
• 金额: $ 12.65万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8282706
• 关键词: Abscess; Academic Medical Centers; Advisory Committees; Antibiotics; Automobile Driving; Axilla; Bathing; Beds; Behavioral; Biometry; Characteristics; Child; Childhood; Clinical; Clinical Investigator; Clothing; Cohort Studies; Communities; Crowding; Cutaneous; Development; Disease; Doctor of Medicine; Enrollment; Environment; Environmental Pollution; Epidemic; Epidemiology; Exposure to; Faculty; Future; General Population; Goals; Health; Healthcare; Home environment; Hospitals; Household; Hygiene; Immunocompetent; Incidence; Individual; Infection; Infection prevention; Infectious Disease Epidemiology; Institution; Intervention; K-Series Research Career Programs; Laundering; Life; Logistic Regressions; Longitudinal Studies; Mentors; Mentorship; Methods; Modeling; Molecular; Molecular Epidemiology; Morbidity - disease rate; Nose; Nursing Homes; Participant; Patients; Pediatric Hospitals; Persons; Physicians; Prevention; Public Health; Recreation; Recruitment Activity; Recurrence; Research; Research Personnel; Risk; Risk Factors; Role; Sampling; Scientist; Source; Specific qualifier value; Sports; Surface; Surveys; Testing; Therapeutic; Time; Training; Universities; Visit; Washington; Work; burden of illness; career development; cohort; community based participatory research; community burden; evidence based guidelines; experience; improved; indexing; member; methicillin resistant Staphylococcus aureus; microbial; modifiable risk; mortality; novel; patient oriented research; pressure; prevent; programs; prospective; research and development; therapy design; transmission process

DESCRIPTION (provided by applicant): This application for a K23 Career Development Award proposes a four-year program to provide the candidate with mentored training in patient-oriented research, protected time, and coursework in advanced epidemiology, biostatistics, and community-based participatory research. The long- term goals of the candidate are to become an independent physician-scientist at an academic medical center, investigating the epidemiology of community-associated methicillin-resistant Staphylococcus aureus (CA- MRSA) and the molecular mechanisms driving staphylococcal transmission, leading to the development of novel methods for the prevention and treatment of CA-MRSA infections. The proposed work will be performed at Washington University and St. Louis Children's Hospital under the mentorship of Victoria Fraser, M.D., an accomplished clinical investigator in infectious diseases epidemiology. A faculty advisory committee consisting of experienced clinical and basic researchers will facilitate the candidate's research and career development. Epidemic strains of CA-MRSA cause significant morbidity and mortality among immunocompetent individuals, especially children, ranging from superficial cutaneous abscesses to invasive infections. CA- MRSA infections have been observed to cluster in households. However, the interplay of household colonization pressure and transmission, hygiene and behavioral risk factors, and environmental contamination influencing CA-MRSA colonization and infection has not been specified. These risk factors must be defined to develop evidence-based guidelines to interrupt CA-MRSA transmission and prevent infections. Understanding the impact of these variables will inform practice to improve health and decrease the burden of CA-MRSA colonization and disease. Preliminary studies demonstrate that household members of index patients with CA-MRSA infection and colonization are also colonized with CA-MRSA. A one-year prospective cohort study of 135 pediatric patients with CA-MRSA infection and their household members will be performed. Using mixed effects logistic regression modeling, the relationships among risk factors at multiple levels (including household colonization pressure, host behavioral practices, and contamination of household surfaces) will be elucidated to identify factors conferring the greatest risks for CA-MRSA colonization, infection, and transmission. Three integrated specific aims are proposed: 1) Define the transmission dynamics of CA-MRSA colonization and infection among pediatric index patients and their household contacts over one year, and determine the contribution of CA-MRSA colonization to subsequent CA-MRSA infection; 2) Identify hygiene and behavioral practices contributing to CA-MRSA transmission, colonization, and infection within households; and 3) Determine the role of environmental contamination and household characteristics in household CA-MRSA transmission. PROJECT NARRATIVE: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a significant public health problem causing infections in healthy people. The proposed research will define how CA-MRSA is transmitted within households and identify risk factors for colonization and infection. The results will be used to design interventions to prevent CA-MRSA infections.

描述（由申请人提供）：这份 K23 职业发展奖申请提出了一个为期四年的计划，为候选人提供以患者为导向的研究、受保护时间以及高级流行病学、生物统计学和基于社区的参与性研究方面的课程作业的指导培训。候选人的长期目标是成为学术医疗中心的独立医师科学家，研究社区相关耐甲氧西林金黄色葡萄球菌（CA-MRSA）的流行病学以及驱动葡萄球菌传播的分子机制，从而开发预防和治疗 CA-MRSA 感染的新方法。拟议的工作将在华盛顿大学和圣路易斯儿童医院在医学博士维多利亚·弗雷泽（Victoria Fraser, M.D.）的指导下进行，她是一位在传染病流行病学领域颇有成就的临床研究者。由经验丰富的临床和基础研究人员组成的教职顾问委员会将促进候选人的研究和职业发展。 CA-MRSA 流行株在免疫功能正常的个体中，尤其是儿童中，造成显着的发病率和死亡率，包括浅表皮肤脓肿和侵袭性感染。据观察，CA-MRSA 感染在家庭中聚集。然而，家庭定植压力和传播、卫生和行为风险因素以及影响 CA-MRSA 定植和感染的环境污染之间的相互作用尚未明确。必须定义这些风险因素，以制定基于证据的指南，以中断 CA-MRSA 传播并预防感染。了解这些变量的影响将为改善健康和减轻 CA-MRSA 定植和疾病负担的实践提供信息。初步研究表明，CA-MRSA 感染和定植指标患者的家庭成员也被 CA-MRSA 定植。将对 135 名 CA-MRSA 感染儿科患者及其家庭成员进行为期一年的前瞻性队列研究。使用混合效应逻辑回归模型，将阐明多个层面的风险因素之间的关系（包括家庭定植压力、宿主行为习惯和家庭表面污染），以确定导致 CA-MRSA 定植、感染和传​​播最大风险的因素。提出了三个综合的具体目标：1）定义儿科指标患者及其家庭接触者一年内 CA-MRSA 定植和感染的传播动态，并确定 CA-MRSA 定植对随后 CA-MRSA 感染的贡献； 2) 确定导致 CA-MRSA 在家庭内传播、定植和感染的卫生和行为习惯； 3) 确定环境污染和家庭特征在家庭 CA-MRSA 传播中的作用。 项目叙述：社区相关的耐甲氧西林金黄色葡萄球菌 (CA-MRSA) 是一个重大的公共卫生问题，会导致健康人群感染。拟议的研究将确定 CA-MRSA 如何在家庭内传播，并确定定植和感染的风险因素。研究结果将用于设计预防 CA-MRSA 感染的干预措施。