Recurrent MRSA Infections: A Study of Risk Factors and Molecular Epidemiology

复发性 MRSA 感染：危险因素和分子流行病学研究

• 批准号: 8268971
• 负责人: Michael Zdenek David
• 金额: $ 12.66万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8268971
• 关键词: Aftercare; Anatomic Sites; Antibiotic Therapy; Antibiotics; Biology; Blood; Caring; Case-Control Studies; Characteristics; Chicago; Chronic; Clinical; Cohort Studies; Collection; Communicable Diseases; Communities; Comorbidity; Complement; Databases; Diagnosis; Disease; Ecology; Enrollment; Environment; Epidemic; Epidemiology; Exposure to; Future; Gastrointestinal tract structure; Genetic; Genetic Predisposition to Disease; Genotype; Goals; HIV; Healthcare; Healthcare Systems; Household; Human; Incidence; Individual; Infection; Intervention; Jail; Life; Literature; Medical; Medical Records; Medical center; Modality; Molecular Epidemiology; Monitor; Monobactams; Nose; Organism; Patients; Pneumonia; Population; Predisposition; Prospective Studies; Protocols documentation; Recurrence; Recurrent disease; Reporting; Research; Research Personnel; Risk; Risk Factors; Role; Safety; Sepsis; Site; Skin; Skin Tissue; Soft Tissue Infections; Specialist; Staphylococcus aureus; Surveillance Program; Techniques; Time; United States; Universities; Vaccines; burden of illness; clinical epidemiology; cohort; demographics; high risk; medical attention; men who have sex with men; methicillin resistant Staphylococcus aureus; microbial; pathogen; patient oriented; prevent; prospective; public health relevance; resistant strain; skills; stem; surveillance data

DESCRIPTION (provided by applicant): Staphylococcus aureus is among the most common bacterial pathogens in human beings. The epidemiology of methicillin-resistant S. aureus (MRSA), which are strains resistant to all ¿-lactam antibiotics, has changed dramatically in the past fifteen years. While MRSA infections before that time occurred almost exclusively within the health care environment and in patients with health care exposure, since the mid-1990s, new strains of MRSA have arisen that are causing an epidemic of infections in the community, particularly skin and soft tissue infections but also less common severe, invasive infections. These community-associated (CA-) MRSA strains differ from the older healthcare-associated (HA-) MRSA strains in the population that they infect, in the type of infections that they cause, and in the genetic characteristics of the strains themselves. MRSA is often a commensal organism, living on the skin, in the gastrointestinal tract, and in the nose of individuals, and asymptomatic carriage is thought to be common before an infection occurs. MRSA infections often recur in patients, but it is not known which patients are at highest risk for recurrence nor whether CA- or HA-strains are more likely to cause recurrence. In the era of CA-MRSA, it is not known if patients with persistent carriage of MRSA are at elevated risk of recurrent MRSA infections. There are interventions that may decrease the likelihood of recurrent MRSA infections in an individual: decolonization protocols, cleaning of fomites, antibiotic therapies, and vaccines are all potentially relevant avenues for the future control of MRSA in the community. Each of these modalities will require further study to assess its efficacy and safety. Patients with recurrent MRSA disease are likely to benefit from such interventions, and the control of MRSA infections in this population may be critical to stemming the dissemination of CA-MRSA in the U.S. In this a two-part study, using a collection of >13,800 stored clinical S. aureus strains, obtained through surveillance at the University of Chicago Medical Center (UCMC), I will attempt to define risk factors for recurrent MRSA infections. First, using existing surveillance data from UCMC in 2003-9, in a case-control study treating those with multiple infections as the cases and those with a single infection as controls, I will examine the following as risk factors for re- infection: anatomic site of first infection, genotype of first and subsequent infecting MRSA strains including CA- and HA-MRSA strain characteristics, patient demographic characteristics, previous exposures to the health care system, and patient comorbidities. Second, nesting a prospective cohort study of recurrent MRSA infections in surveillance at UCMC, I will enroll 400 patients with incident MRSA infections and monitor them for two years. I will determine how frequently these patients have recurrent MRSA infections, how commonly they seek medical attention for the infections, the presence of the risk factors for re-infection listed above, and the genotypes of MRSA strains associated with infections and any identified asymptomatic colonization to assess the role of chronic colonization in the recurrence of MRSA infections. Public Health Relevance: Infections caused by methicillin-resistant Staphylococcus aureus (MRSA), once limited to patients with exposures to the health care system, are becoming common in the healthy population of the United States. While many people have recurrent skin, blood or other MRSA infections after treatment for a first infection, it is not known which patients are at high risk for such recurrences. The goal of this study is to determine the risk factors that predict recurrent MRSA infections by studying the demographics, medical treatments given, and medical problems of MRSA patients, the types of infection caused by MRSA, and the genetic characteristics of MRSA strains that cause initial and recurrent infections.

描述（由应用提供）：金黄色葡萄球菌是人类中最常见的细菌病原体之一。在过去的十五年中，对所有抗甲氧霉菌的金黄色葡萄球菌（MRSA）的流行病学已经发生了巨大变化。虽然在此之前的MRSA感染几乎完全发生在医疗保健环境中和医疗保健暴露的患者中，但自1990年代中期以来，新的MRSA菌株已经引起了社区中感染的流行，尤其是皮肤和软组织感染，但也较少，但也较少常见，但也是常见的严重严重感染。这些与较旧的医疗保健相关（HA-）MRSA菌株不同的（CA-）MRSA菌株在他们感染的人群中，其引起的感染类型以及菌株本身的遗传特征。 MRSA通常是一种共生生物，生活在皮肤上，胃肠道和个体的鼻子中，并且在感染发生之前被认为是常见的。 MRSA感染经常在患者中复发，但尚不清楚哪些患者患有最高的复发风险，或者CA-或HA-strains是否更可能引起复发。在CA-MRSA时代，尚不清楚MRSA持续携带者的患者是否患有MRSA感染的风险较高。有一些干预措施可能会降低一个个体中MRSA反复感染的可能性：非殖民化方案，清洁fomite，抗生素疗法和疫苗都是社区中MRSA未来控制的潜在相关途径。这些方式中的每一个都需要进一步研究以评估其有效性和安全性。复发MRSA疾病的患者可能会从这种干预措施中受益，并且在这项两部分研究中，使用> 13,800个储存的临床S. Aureus菌株（通过芝加哥大学的固定范围）获得了> 13,800份的临床S. Aureus菌株（ucmc），MR S. Aureus菌株（UCMC），MRSA在美国的传播可能至关重要感染。首先，在一项病例对照研究中，使用来自UCMC的现有监视数据，将多种感染作为病例和单个感染作为对照的患者进行治疗，我将研究以下作为重新感染的风险因素：首次和随后的序列特征在于CA-MRSA的特征，包括CA-MRSA的特征，包括CA-MRA的特征，包括CA-MRA的特征。医疗保健系统和患者合并症。其次，在UCMC监测中，对经常性MRSA感染的前瞻性队列研究嵌套，我将招募400例出现MRSA感染的患者，并监测它们两年。我将确定这些患者经常患有MRSA感染的频率，他们对感染的普遍关注，上述重新感染的危险因素的存在以及MRSA菌株的基因型与感染和任何鉴定出的渐近定殖有关，以评估MRSA感染复发中慢性共生的作用。 公共卫生相关性：由耐甲氧西林的金黄色葡萄球菌（MRSA）引起的感染，曾经仅限于暴露于医疗保健系统的患者，在美国健康人群中变得很普遍。虽然许多人在治疗初期感染后患有皮肤，血液或其他MRSA感染，但尚不清楚哪些患者患这种复发的风险很高。这项研究的目的是通过研究MRSA患者的人口统计学，医疗治疗和医疗问题，MRSA引起的感染类型以及MRSA菌株的遗传特征来确定预测MRSA感染的危险因素，以及引起初始感染和再生感染的MRSA遗传特征。