Comparative Effectiveness of Strategies to Control S. aureus Infections

描述（由申请人提供）： 金黄色葡萄球菌感染与全球医院（包括VA医疗保健系统）中相当高的发病率和死亡率相关。Schweizer博士的长期职业目标是制定和评估循证策略，以减少VA医疗保健系统中与医疗保健相关感染相关的患病率和不良结局。该应用程序的目的是为Schweizer博士提供在比较有效性研究，使用国家VA数据库，传染病数学建模和实施科学方面进行特定培训的机会，以帮助她发展成为一名独立的VA卫生服务研究员，专门从事医院相关感染预防。本申请的目的是比较预防和治疗S。金黄色葡萄球菌感染针对S.金黄色葡萄球菌的预防和治疗。不幸的是，所有这些都有优点和缺点，几乎没有证据支持这些策略的有效性。 目前的文献评估战略，以防止S。金黄色葡萄球菌传播往往缺乏外部效度，因此很难将研究结果应用于不同的患者人群。2007年，美国退伍军人健康管理局（VHA）对耐甲氧西林的S。金黄色葡萄球菌（MRSA）预防倡议要求所有VA医疗中心对所有入院患者的鼻子进行MRSA测试，并限制与MRSA阳性患者的接触，以防止MRSA传播。然而，很少有研究将这种策略与其他潜在策略进行比较，以确定这是否是最有效的策略。 有效和具有成本效益的战略，以减少传播。MRSA是一种抗生素耐药性 色葡萄金黄色葡萄球菌，占所有S.金黄色葡萄球菌感染因此，旨在预防MRSA和甲氧西林敏感的S。金黄色葡萄球菌（MSSA）可能比仅关注MRSA的策略更有效。此外，关于S的最佳治疗方法几乎没有共识。金黄色葡萄球菌感染许多医生开抗生素万古霉素治疗所有的沙门氏菌。 金黄色葡萄球菌感染，尽管这可能不是最佳的。本研究建议的三个目的是：1）完成系统的回顾和荟萃分析的有效性和成本的不同组织层面的S。实施的金黄色葡萄球菌感染预防策略：a）在所有住院患者中; B）在通过医疗保健系统过渡的患者中; 2）比较万古霉素与其他抗葡萄球菌抗生素治疗侵袭性金黄色葡萄球菌的有效性。金黄色葡萄球菌（MRSA和MSSA）感染; 3）使用目标1和2中收集的组织级和患者级数据，创建一个决策模型，以比较预防和治疗S.金黄色葡萄球菌感染VHA通过VHA MRSA预防计划投入了大量的时间和资源来预防MRSA传播和感染。这项研究是一致的使命的VHA试图确定最有效和成本效益的战略，可以实施的VHA MRSA预防倡议，以预防和治疗S。金黄色葡萄球菌（包括MRSA）感染。从而防止S。金黄色葡萄球菌相关的发病率和死亡率在我们国家的退伍军人。本研究将利用荟萃分析、大型VA回顾性队列研究和数学模型来评估最有效和最具成本效益的策略，以减少与S相关的传播、感染和死亡。金黄色。这些数据是不可或缺的预防和治疗S。金黄色葡萄球菌侵袭性感染。

DESCRIPTION (provided by applicant): Staphylococcus aureus infections are associated with considerable morbidity and mortality in hospitals worldwide including the VA Healthcare System. Dr. Schweizer's long term career goal is to develop and evaluate evidence based strategies to reduce the prevalence of and poor outcomes associated with healthcare-associated infections in the VA Healthcare System. The purpose of this application is to provide Dr. Schweizer with opportunities for specific training in comparative effectiveness research, use of national VA databases, mathematical modeling of infectious diseases, and implementation science to assist in her development as an independent VA health services researcher specializing in hospital-associated infection prevention. The objective of this application is to compare the effectiveness of strategies to prevent and treat S. aureus infections. Multiple organization-level and patient-level strategies have been proposed for S. aureus prevention and treatment. Unfortunately, all have advantages and disadvantages, and there is little evidence to support the effectiveness of these strategies. The current literature assessing strategies to prevent S. aureus transmission often lack external validity, thus it is difficult to apply study results to different patient populations. In 2007, th Veterans Health Administration (VHA) Methicillin-resistant S. aureus (MRSA) Prevention Initiative mandated that all VA Medical Centers test the noses of all admitted patients for MRSA and limit contact with MRSA positive patients in order to prevent MRSA spread. However, few studies have compared this strategy to other potential strategies to determine if this is the most effective and cost-effective strategy to reduce transmission. MRSA is an antibiotic resistant form of S. aureus and comprises approximately half of all S. aureus infections. Thus, strategies that aim to prevent both MRSA and methicillin-susceptible S. aureus (MSSA) may be more effective than strategies solely focused on MRSA. Additionally, there is little consensus on the optimal treatment for S. aureus infections. Many physicians prescribe the antibiotic vancomycin for all S. aureus infections although this may not be optimal. The three aims of this research proposal are: 1) Complete a systematic review and meta-analysis of the effectiveness and costs of different organization-level S. aureus infection prevention strategies implemented: a) Among all admitted patients; b) Among patients who are transitioning through the healthcare system; 2) Compare the effectiveness of vancomycin to that of other anti-staphylococcal antibiotics for the treatment of invasive S. aureus (MRSA and MSSA) infections; and 3) Using organization-level and patient-level data collected in Aims 1 and 2, create a decision model to compare the effectiveness, costs, and cost-effectiveness of strategies to prevent and treat S. aureus infections. The VHA has invested considerable time and resources into the prevention of MRSA transmission and infection through the VHA MRSA Prevention Initiative. This study is consistent with the mission of the VHA in attempting to determine the most effective and cost-effective strategies that can be implemented by the VHA MRSA Prevention Initiative to prevent and treat S. aureus (including MRSA) infections. Thus preventing S. aureus related morbidity and mortality among our nation's veterans. This study will utilize a meta-analysis, a large VA retrospective cohort study, and mathematical models to assess the most effective and cost- effective strategies to reduce transmission, infection, and mortality related to S. aureus. These data are integral to the prevention and treatment of S. aureus invasive infections.