Effectiveness of Treatment and Outcomes for Veterans Infected with Resistant Gram-negative Organisms.

年，美国每年大约发生70万至170万与医疗保健相关的感染(HAI) 在美国急诊社区医院接受护理的住院患者。这些感染中的许多是由 由抗生素耐药生物，包括耐多药革兰氏阴性菌(MDRGNO)。一 感染耐药生物后的发病率和死亡率的主要预测因素之一是 感染的经验性和决定性的抗生素治疗不充分。缺乏具体的临床实践 这些微生物的治疗指南增加了有效治疗策略的模糊性。它是 不清楚退伍军人管理局正在使用什么治疗方案来治疗MDRGNO，也不清楚其疗效如何 他们是。因此，这项研究的目标是使用国家退伍军人管理局数据来描述当前的治疗策略 对部分MDRGNO(碳青霉烯耐药肠杆菌科(CRE)、铜绿假单胞菌和 不动杆菌种)以及这些策略对退伍军人结局的比较有效性。 这项研究与退伍军人中寻求治疗的患者高度相关，因为退伍军人经历了许多风险因素 与MDRGNO感染的发展有关。退伍军人管理局治疗病情严重复杂的患者 需要经常住院或接触医疗保健或使用侵入性设备(即脊髓 受伤、截肢)，使他们面临感染的风险。MDRGNOS和治疗不当会导致 对那些病情复杂的人的发病率和死亡率结果有重大影响。此外，建议的 研究与退伍军人管理局的多药耐药生物(MDRO)计划有关，该计划已经开发和 实施国家方案，减少耐甲氧西林金黄色葡萄球菌和艰难梭菌的传播和传播。 我们的发现将产生MDRGNO结果的有效性数据，包括CRE在不同的 退伍军人人口，可供退伍军人方案办公室用来制定治疗指南。这 这项研究具有创新性，因为据我们所知，这将是第一次利用国家VA微生物学进行研究， 药房和医疗接触数据库，以回答有关比较有效性的研究问题 MDRGNO的有效治疗策略。长期目标将是开发可操作的调查结果 可以实施的决策者，以提高治疗和保健的有效性 不同人群中感染MDRGNO的患者。

Approximately 0.7 to 1.7 million health care-associated infections (HAIs) occur in the U.S. each year in inpatients receiving care in U.S. acute care community-hospital stays. Many of these infections are caused by antibiotic resistant organisms including multidrug resistant gram-negative organisms (MDRGNOs). One of the prime predictors of morbidity and mortality following infection with drug resistant organisms is inadequate empiric and definitive antibiotic treatment of the infection. Lack of specific clinical practice guidelines for treatment of these organisms increases the ambiguity of effective treatment strategies. It is unclear what treatment regimens are being used within VA for treatment of MDRGNOs nor how effective they are. Therefore, the goal of this study is to use national VA data to describe current treatment strategies for select MDRGNOs (Carbapenem Resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa, and Acinetobacter species) and the comparative effectiveness of these strategies on outcomes in Veterans. This study is highly relevant to patients seeking care in VA, as Veterans experience many of the risk factors associated with development of an MDRGNO infection. VA treats patients with serious complex conditions that require frequent hospitalization or contact with health care or use of invasive devices (i.e. spinal cord injury, amputations) that put them at risk for infections. MDRGNOS and inadequate treatment have a significant impact on morbidity and mortality outcomes in those with complex conditions. Also, the proposed research is related to the VA's Multidrug Resistant Organism (MDRO) Program that has developed and implemented national programs to reduce the transmission and spread of MRSA and Clostridium difficile. Our findings will produce effectiveness data on outcomes for MDRGNOs including CRE in a diverse population of Veterans that can be used by VA program offices for developing guidance for treatment. This research is innovative in that it will be the first study, to our knowledge, utilizing national VA microbiology, pharmacy, and medical encounter databases to answer comparative effectiveness research questions on effective treatment strategies for MDRGNOs. The long-term goal will be to develop actionable findings for decision makers that can be implemented to improve the effectiveness of treatment and healthcare of patients with MDRGNO infections across different populations.