Decreasing Neonatal Staphylococcus aureus Disease Through Parental Intervention

通过家长干预减少新生儿金黄色葡萄球菌疾病

• 批准号: 8668318
• 负责人: AARON M MILSTONE
• 金额: $ 43.96万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8668318
• 关键词: Decreasing; Neonatal; Staphylococcus; aureus; Disease

Project Summary Each year in the U.S. nearly 500,000 babies are born prematurely. Premature births are a leading cause of long-term neurologic disabilities in children and cost more than $26 billion per year. Premature infants are cared for in the neonatal intensive care unit (NICU) where more than 33,000 develop a healthcare associated infection (HAI). HAIs are estimated to result in $28-45 billion in healthcare costs annually. In addition to the short-term costs of HAIs, neonatal infections contribute to devastating neurologic disabilities and poor growth outcomes. Staphylococcus aureus (S. aureus) is the second most common pathogen causing HAIs in neonates. Out of 57,000 very low birth weight infants, an estimated 3.7% develop bloodstream or central nervous system S. aureus infections annually with an attributable mortality of 25%. Despite aggressive measures to prevent S. aureus infections in neonates, the burden of S. aureus disease remains high in this population. We propose a new paradigm to prevent S. aureus HAIs in neonates. Parents, rather than healthcare workers, may be a key reservoir from which neonates acquire S. aureus colonization in the NICU. This finding is consistent with a changing NICU environment where skin-to-skin contact between parents and neonates is encouraged and may promote S. aureus transmission, while at the same time, common hospital infection prevention measures have reduced healthcare worker transmission of S. aureus. The long term objective of this proposal is to prevent HAIs in neonates, especially those caused to S. aureus. The specific aims are Aim 1) to assess S. aureus colonization and strain concordance amongst parents and neonates in the NICU, Aim 2) to measure the effect of treating parents with short course intranasal mupirocin and topical chlorhexidine antisepsis on acquisition of S. aureus colonization in neonates in a randomized controlled trial. We will assemble a cohort of neonates admitted to the NICU and their parents and follow them longitudinally to measure acquisition of S. aureus colonization in neonates in the NICU and determine the role of parents in postnatal S. aureus transmission. Some neonate-parent pairs will be randomized, and parents will receive treatment or control to eradicate S. aureus colonization. The findings of this proposal could change the paradigm of HAI prevention in the NICU from one that focuses on healthcare workers and the environment to one that recognizes parents and visitor as important sources of exposure to pathogens that contribute to HAIs.

项目摘要 在美国，每年有近50万名婴儿早产。早产是导致早产的主要原因。 儿童的长期神经功能障碍，每年花费超过260亿美元。早产儿 在新生儿重症监护室（NICU）接受护理，超过33，000名新生儿在NICU中发展出与医疗保健相关的 感染（HAI）。据估计，HAI每年将导致280 - 450亿美元的医疗保健成本。除了有 HAI的短期成本、新生儿感染会导致破坏性的神经功能障碍和生长不良 结果。金黄色葡萄球菌(S.金黄色葡萄球菌）是引起HAI的第二常见病原体 新生儿。在57，000名极低出生体重儿中，估计有3.7%发育为血流或中枢性贫血。 神经系统S。金黄色葡萄球菌感染，可归因死亡率为25%。尽管进行了积极 防治措施。新生儿金黄色葡萄球菌感染、S.金黄色葡萄球菌病在这一地区仍然很高 人口我们提出了一种新的防止S.新生儿金黄色葡萄球菌HAI。父母，而不是 医护人员，可能是新生儿获得S.新生儿重症监护室的金黄色葡萄球菌定植。 这一发现与不断变化的NICU环境相一致，在这种环境中，父母和监护人之间的皮肤接触 对新生儿的生长发育有促进作用。而与此同时，普通医院 感染预防措施已经减少了医护人员传播S.金黄色。长期 本提案的目的是预防新生儿HAI，特别是由S.金黄色。具体 目的：目的1）评价S.金黄色葡萄球菌定植及父母和新生儿菌株一致性研究 NICU，目的2），以评估使用短程鼻内莫匹罗星和局部莫匹罗星治疗父母的效果 洗必泰对S.新生儿金黄色葡萄球菌定植的随机对照试验。 我们将收集入住NICU的新生儿及其父母的队列，并纵向随访至 测量S.新生儿重症监护病房新生儿金黄色葡萄球菌定植情况，并确定父母在新生儿金黄色葡萄球菌定植中的作用 出生后S.金黄色葡萄球菌传播。一些新生儿-父母配对将随机化，父母将接受 以根除S.金黄色葡萄球菌定植。这项建议的结果可能会改变 NICU中HAI预防的范式从关注医护人员和环境到 一个承认父母和来访者是导致HAI的病原体暴露的重要来源。