Hospital-Acquired Mupirocin-Resistant MRSA in Post-Partum Women and Newborns

产后妇女和新生儿中医院获得的莫匹罗星耐药 MRSA

• 批准号: 8431275
• 负责人: Sharon Beth Brodie Wright
• 金额: $ 49.13万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8431275
• 关键词: Hospital; Acquired; Mupirocin; Resistant; MRSA

Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of significant morbidity among hospitalized and community-dwelling persons. Initially described as a hospital- and healthcare-associated pathogen, new strains of community-associated MRSA (CA-MRSA) have emerged as an important cause of infection among of community-dwelling individuals. More recently CA-MRSA, as defined by pulsed-field gel electrophoresis, a form of "DNA fingerprinting", has become a growing cause of healthcare-acquired infection. A large outbreak of infection caused by a highly pathogenic strain of CA-MRSA (USA300-0114) occurred at a large urban teaching hospital among post-partum women and newborns soon after discharge. Resistance to mupirocin was noted in a large proportion of isolates during the outbreak, which was an unusual and unexpected finding. Risk factors for colonization and infection with hospital-associated strains of MRSA (HA-MRSA) are fairly well established, but the risk factors for CA-MRSA colonization and infection in this high risk population remain poorly defined. By the use of novel, advanced statistical modeling, the current study aims to delineate the risk factors for colonization and infection with mupirocin-resistant and mupirocin-susceptible strains of CA-MRSA USA300-0114 during this outbreak. Given the dynamic nature of the newborn nursery, the setting in which transmission is suspected to have occurred, transmission dynamics and transmission rates will be determined using an open Susceptible-Infected-Recovered model. Finally, laboratory studies to determine the genetic makeup and other characteristics of the colonizing and infecting MRSA isolates will be performed in parallel with the clinical epidemiological investigations with the aim of determining mechanisms by which resistance to topical antimicrobial agents is spread and possible linkage between pathogen virulence and resistance. The proposed study will examine risk factors for colonization and infection in this population, however, some of the findings will likely be generalizable to CA-MRSA transmission in other populations both in the outbreak and non-outbreak setting. Furthermore, important information regarding development of resistance and mechanisms of resistance to topical agents commonly used in decolonization will be obtained. This information will ultimately have implications for the use of these agents in routine infection control and decolonization.

摘要： 耐甲氧西林金黄色葡萄球菌(MRSA)是导致住院和 居住在社区的人。最初被描述为与医院和医疗保健相关的病原体，新的 社区相关耐甲氧西林金黄色葡萄球菌(CA-MRSA)菌株已成为 居住在社区中的个体。最近，根据脉冲场凝胶电泳的定义，CA-MRSA 这种形式的“DNA指纹”已成为医疗保健获得性感染的一个日益增长的原因。一场大规模的流感暴发 某大型城市教师发生CA-MRSA高致病性菌株(USA300-0114)感染 在产后妇女和新生儿出院后不久的医院。对莫匹罗星的耐药性在 在暴发期间发现了很大比例的分离株，这是一个不同寻常和意想不到的发现。 医院相关MRSA菌株(HA-MRSA)的定植和感染的危险因素相当好 已经确定，但CA-MRSA在这一高危人群中定植和感染的危险因素仍然存在 定义不明确。通过使用新的、先进的统计模型，本研究的目的是描绘风险 耐莫匹罗星和敏感的CA-MRSA定植和感染因素分析 在这次暴发期间，USA300-0114。鉴于新生儿托儿所的动态性质， 如果怀疑发生了传输，则将确定传输动态和传输速率 使用一种开放的易感感染-康复模型。最后，实验室研究确定了基因 定植和感染MRSA分离株的组成和其他特性将并行进行 进行临床流行病学调查，目的是确定抗药性的机制 局部抗菌剂正在传播，病原菌的毒力和耐药性之间可能存在联系。 这项拟议的研究将检查在这一人群中殖民和感染的风险因素，然而，一些 这些发现可能会推广到CA-MRSA在其他人群中的传播，无论是在疫情爆发还是在 非爆发设置。此外，有关抗药性发展的重要信息 将获得对非殖民化中常用的局部制剂的抵抗机制。此信息 最终将对这些制剂在常规感染控制和非殖民化中的使用产生影响。