Southeastern Pennsylvania Adult and Pediatric Prevention Epicenter Network

描述（由申请方提供）：医疗保健相关感染（HAI），特别是由耐药病原体引起的HAI非常常见，并与发病率、死亡率和成本显著增加相关。近年来，由于抗生素的过度使用，抗生素耐药性显著增加。然而，限制不必要的抗生素使用的努力收效甚微。抗生素使用不当主要是由于无法确定不需要经验性抗生素的情况。生物标志物在决定停止抗生素治疗方面的作用仍不清楚，特别是在重症成人中。在儿童中进行的研究更少。生物标志物干预的经济影响尚不清楚。 该项目的目标是减少重症监护室（ICU）环境中不必要的抗生素使用。该研究的第一阶段将确定最能识别细菌感染可能性极低的重症患者的生物标志物。在第二阶段，将测试基于生物标志物的算法对减少抗生素使用的影响。最后，我们将扩大特拉华州山谷病例控制网络（DVCCN）的范围，以解决未来疾病预防控制中心预防中心的倡议。具体的研究阶段和目的是：I期：候选生物标志物的测试特征目的1：评估候选生物标志物的测试特征，用于在重症成人中识别细菌感染可能性极低的患者目的2：评估候选生物标志物的测试特征，用于在重症儿童中识别细菌感染可能性极低的患者。第二阶段：基于生物标志物的算法对抗生素使用的影响目的3：评估基于生物标志物的算法对减少危重成人中抗生素使用的影响目的4：评估基于生物标志物的算法对减少重症儿童抗生素使用的影响目的3和4的假设是使用生物标志物-的算法将与抗生素使用的显著减少相关次要目标1：确定生物标志物算法在成人中的增量成本（节省）次要目标2：确定生物标志物算法在儿童中的增量成本（节省）扩大DVCCN的范围，用于未来的CDC预防中心倡议这项工作将为生物标志物的潜在影响提供重要的见解-减少危重病人不必要的抗生素使用。完善的DVCCN合作将提供一个特殊的临床站点网络，在其中进行未来的CDC预防中心计划

DESCRIPTION (provided by applicant): Healthcare-associated infections (HAIs), particularly those due to antimicrobial-resistant pathogens, are very common and are associated with significant increases in morbidity, mortality, and cost. Antimicrobial resistance has increased markedly in recent years due to overuse of antimicrobials. However, efforts to limit unnecessary antibiotic use have met with little success. Inappropriate antibiotic use is largely driven by the inability to identify conditions for which empiric antibiotics are unnecessary. The role of biomarkers in informing decisions to stop antibiotic therapy remains unclear, especially in critically ill adults. Even fewer studies have been conducted in children. The economic impact of biomarker interventions is unknown. The goal of this project is to reduce unnecessary antibiotic use in the intensive care unit (ICU) setting. Phase I of the study will identify the biomarker(s) that best identify critically ill patients who have a very low likelihood of bacterial infection. In Phase II, the impact of a biomarker-based algorithm on reducing antibiotic use will be tested. Finally, we will expand the scope of the Delaware Valley Case Control Network (DVCCN) to address future CDC Prevention Epicenter initiatives. The specific study phases and aims are: Phase I: Test Characteristics of Candidate Biomarkers Aim 1: to assess the test characteristics of candidate biomarkers for identifying patients with very low likelihood of bacterial infection among critically ill adults Aim 2: to assess the test characteristics of candidate biomarkers for identifying patients with very low likelihood of bacterial infection among critically ill children The hypotheses for Aims 1 and 2 are that a biomarker or combination of biomarkers can be identified that demonstrates a high negative predictive value for bacterial infection Phase II: Impact of a Biomarker-Based Algorithm on Antibiotic Use Aim 3: to evaluate the impact of a biomarker-based algorithm on reducing antibiotic use in critically ill adults Aim 4: to evaluate the impact of a biomarker-based algorithm on reducing antibiotic use in critically ill children The hypotheses for Aims 3 and 4 are that use of the biomarker-based algorithm will be associated with significant reductions in antibiotic use Secondary Aim 1: to determine incremental costs (savings) of the biomarker algorithm in adults Secondary Aim 2: to determine incremental costs (savings) of the biomarker algorithm in children Aim 5: to expand the scope of the DVCCN for future CDC Prevention Epicenter initiatives This work will provide crucial insights into the potential impact of biomarker-based algorithms on reducing unnecessary antibiotic use in critically ill patients. The well-established DVCCN collaborative will provide an exceptional network of clinical sites within which to conduct future CDC Prevention Epicenter initiatives