Extra-nasal Colonization and Epidemiology of Community-Associated MRSA

描述（由申请人提供）：凯尔波波维奇博士，在拉什大学（RUMC）医学系的临床讲师，寻求研究和职业发展的支持，以建立一个职业生涯作为一个独立的临床调查员在医院流行病学领域。她的研究兴趣是社区相关的耐甲氧西林金黄色葡萄球菌（CA-MRSA）;她是4篇同行评审手稿的第一作者，发表了2篇评论文章，并共同撰写了2篇关于CA-MRSA的社论，并在全国会议的口头科学会议上发表了6篇她的工作摘要。Popovich博士将在医疗流行病学国际领导者Robert Weinstein博士、RUMC临床微生物学部主任、医院流行病学资深研究员玛丽海登（医学博士）和巴拉霍塔博士（共同导师）的指导下工作，霍塔博士是一名在感染监测生物统计学和计算机算法方面具有专长的研究人员。除了这个核心的跨学科导师团队，4名顾问成员将批判性地评估研究和职业发展-CDC的Scott Fridkin博士; Cook County Health and Hospitals System的医院流行病学家Sharon Welbel博士;密歇根大学医学教授（传染病）Carol Kauffman博士;和传染病科主任Gordon Trenholme博士，RUMC。波波维奇博士目前正在芝加哥伊利诺斯大学公共卫生学院攻读流行病学硕士学位，以获得研究方法和生物统计学方面的新技能。她在一个资金充足，培育环境，产生了重大的流行病学和卫生保健相关感染的干预研究。库克县医院和RUMC之间现有的强大的合作研究基础设施以及Popovich博士建议的跨学科方法将使她能够发展成为能够在奖励期结束时申请R-01的独立研究人员所需的基本技能和经验。在之前的研究中，Popovich博士证明CA-MRSA菌株正在取代传统的医院MRSA菌株作为医院感染的原因。CA-MRSA流行目前不成比例地影响特定患者群体（例如，年轻人）。该提议是该提议的延伸，并且具有2个目的：（1）确定CA-MRSA菌株在鼻外部位定殖的程度和（2）确定在年龄= 30的患者中发生的排他性鼻外CA-MRSA定殖的程度。假设是：（1）CA-MRSA菌株的鼻外定殖的流行率高于非CA-MRSA菌株的流行率，和（2）年龄= 30岁的患者组与年龄>30岁的患者相比，鼻外CA-MRSA定殖的流行率高3.5倍。为了检验这些假设，将使用殖民监视和已建立的电子数据仓库。研究结果将为未来的项目（R-01）提供信息，该项目将检查导致医院感染的CA-MRSA菌株的来源，并测试减少CA-MRSA流行病传播的感染预防策略。 相关性：虽然最初影响没有先前医疗暴露的个体，但社区相关的耐甲氧西林金黄色葡萄球菌（CA-MRSA）流行病已成为医院侵入性感染的原因，特定人群受到不成比例的影响。该项目的目标是进一步表征CA-MRSA菌株的流行病学和定殖动力学，以便在医院环境中开发和测试预防策略。

DESCRIPTION (provided by applicant): Dr. Kyle Popovich, Clinical Instructor in the Department of Medicine at Rush University (RUMC), seeks support for research and career development to establish a career as an independent clinical investigator in the field of hospital epidemiology. Her research interest is community-associated methicillin-resistant S.aureus (CA-MRSA); she has been the first author on 4 peer-reviewed manuscripts, has published 2 review articles and co-authored and been the sole author of 2 editorials on CA-MRSA, and has presented 6 abstracts of her work in oral scientific sessions at national meetings. Dr. Popovich will work under the mentorship of Dr. Robert Weinstein, an international leader in healthcare epidemiology; Mary Hayden, MD (co-mentor), Director, Division of Clinical Microbiology, RUMC and an accomplished researcher in hospital epidemiology; and Dr. Bala Hota (co-mentor), an investigator with expertise in biostatistics and computer algorithms for infection surveillance. In addition to this core interdisciplinary mentorship team, 4 advisory members will critically evaluate research and career development-Dr. Scott Fridkin of the CDC; Dr. Sharon Welbel, Hospital Epidemiologist in the Cook County Health and Hospitals System; Dr. Carol Kauffman, Professor of Medicine (Infectious Diseases), University of Michigan; and Dr. Gordon Trenholme, Director, Section of Infectious Diseases, RUMC. Dr. Popovich is acquiring new skills in research methodology and biostatistics by currently taking classes toward a Masters of Science in Epidemiology at the University of Illinois at Chicago, School of Public Health. She is working in a well-funded, nurturing environment that has produced major epidemiologic and intervention studies of healthcare-associated infections. The strong existing infrastructure for collaborative research between Cook County Hospital and RUMC and the interdisciplinary approach of Dr. Popovich's proposal will allow her to develop the essential skills and experience needed to become an independent researcher capable of applying for an R-01 at the end of the award period. In prior studies, Dr. Popovich demonstrated that CA-MRSA strains are replacing traditional hospital MRSA strains as causes of nosocomial infection. The CA-MRSA epidemic is currently disproportionately affecting particular patient populations (e.g., younger adults). This proposal is an extension of this and has 2 aims: (1) determine the extent to which CA-MRSA strains colonize extra-nasal sites and (2) determine the extent to which exclusive extra-nasal CA-MRSA colonization occurs among patients age = 30. Hypotheses are: (1) prevalence of extra-nasal colonization with CA-MRSA strains is higher than that of non-CA-MRSA strains and (2) a cohort of patients age = 30 will have a 3.5 fold greater prevalence of extra-nasal CA-MRSA colonization in comparison to a patients age>30. To test these hypotheses, colonization surveillance and an established electronic data warehouse will be used. Findings will inform a future project (R-01) examining the origin of CA-MRSA strains causing nosocomial infections and testing infection prevention strategies for reducing spread of the CA-MRSA epidemic. Relevance: While originally affecting individuals without prior healthcare exposures, the community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) epidemic has emerged as a cause of invasive infection in the hospital, with particular populations being disproportionately affected. The goal of this project is to further characterize the epidemiology and colonizaiton dynamics of CA-MRSA strains in order develop and test prevention strategies in hospital settings.