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: 8510478
• 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: 2012-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8510478
• 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。通过研究机构级抗生素处方与C。艰难梭菌感染（CDI）率，以及CDI的各种控制策略的影响和成本，我们可以更好地了解C。这将有助于实施旨在控制CDI的VA范围内的举措，例如抗生素管理。该项目的研究结果有可能影响整个VA医疗保健系统的感染控制实践。项目背景C.艰难梭菌是医疗保健相关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，导致住院时间延长、死亡率升高和医疗保健成本增加。暴露于抗生素是CDI最重要的风险因素，可能是通过破坏正常的粪便植物群。虽然已经提出了一些方法来控制CDI的爆发，例如改善手部卫生和抗生素管理，但对这些干预措施如何改变C.难以传播和获取，并有助于其控制。项目目标C.艰难的传播依赖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C的相对影响有助于设计控制医院CDI的政策。艰难的传输动力学。考虑到这一点，我们的目标是（a）对抗生素使用模式和CDI率之间的关联进行设施级分析 （B）将这些模式和关联纳入我们基于代理的医院C模拟中。艰难传播;（c）使用模拟来评估和比较用于C. VA医院的艰难控制，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C。艰难菌株方法我们将改进和提高一个高保真的基于代理的计算机模拟医院C。作为以前项目的一部分创建的艰难传输。我们对抗生素处方和CDI率的分析将基于我们从Patient Care Services获得的VA患者数据的大型全国性数据库。来自150多家VA医院的个人和医院级数据相结合，使得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的模型变得可行。分层混合效应模型将用于描述CDI率与患者和医院水平因素的相关性。这些分析的结果将被纳入模拟，然后将用于评估影响C的各种策略和因素。通过一系列的模拟实验，传统的定量流行病学方法将用于分析模拟结果，重点是C。发病率和传播率作为结果。动态成本效益分析也将通过预测C。在各种替代政策下， 政权。