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，拉什大学(RUMC)医学系临床讲师，寻求对研究和职业发展的支持，以确立在医院流行病学领域作为独立临床调查员的职业生涯。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篇同行评议稿件的第一作者，发表了2篇综述文章，与人合著和单独撰写了2篇关于CA-MRSA的社论，并在全国会议的口头科学会议上提交了6篇工作摘要。波波维奇博士将在以下导师的指导下工作：罗伯特·温斯坦博士，保健流行病学的国际领导者；玛丽·海登医学博士(共同导师)，RUMC临床微生物学部门主任，医院流行病学方面的资深研究员；以及巴拉·霍塔博士(共同导师)，他是一名研究人员，在生物统计学和感染监测计算机算法方面拥有专业知识。除了这个核心的跨学科指导团队，4名顾问成员将对研究和职业发展进行批判性评估--Dr。美国疾病控制与预防中心的Scott Fridkin博士、库克县卫生和医院系统的医院流行病学家Sharon Welbel博士、密歇根大学医学(传染病)教授Carol Kauffman博士和RUMC传染病科主任Gordon Trenholme博士。波波维奇目前在芝加哥伊利诺伊大学公共卫生学院攻读流行病学理学硕士学位，他正在学习研究方法和生物统计学方面的新技能。她的工作环境资金充足，培育良好，已对与医疗保健相关的感染进行了重大流行病学和干预研究。库克县医院和RUMC之间强大的合作研究现有基础设施，以及波波维奇博士提议的跨学科方法，将使她能够发展必要的技能和经验，成为一名能够在获奖期结束时申请R-01的独立研究人员。在之前的研究中，波波维奇博士证明，CA-MRSA菌株正在取代传统的医院MRSA菌株，成为医院感染的原因。CA-MRSA疫情目前正在不成比例地影响特定的患者群体(例如，年轻人)。这项建议是这一建议的延伸，有两个目标：(1)确定CA-MRSA菌株在鼻外部位的定植程度；(2)确定在年龄=30岁的患者中发生鼻外CA-MRSA独有定植的程度。假设是：(1)CA-MRSA菌株鼻外定植的患病率高于非CA-MRSA菌株，(2)年龄=30岁的患者鼻外定植CA-MRSA的患病率将是30岁患者的3.5倍。为了验证这些假设，将使用殖民监视和建立的电子数据仓库。这些发现将为未来的一个项目(R-01)提供信息，该项目将检查引起医院感染的CA-MRSA菌株的来源，并测试感染预防策略，以减少CA-MRSA疫情的传播。 相关性：虽然最初影响的是没有接触过医疗保健的个人，但社区相关的耐甲氧西林金黄色葡萄球菌(CA-MRSA)流行病已经成为医院侵入性感染的一个原因，特定人群受到的影响不成比例。该项目的目标是进一步确定CA-MRSA菌株的流行病学和定植动态，以便在医院环境下制定和测试预防策略。

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.