Understanding and preventing Clostridium difficile transmission from asymptomatically colonized patients

了解和预防无症状定植患者的艰难梭菌传播

• 批准号: 9366025
• 负责人: Daniel J Morgan
• 金额: $ 42.4万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9366025
• 关键词: Understanding; preventing; Clostridium; difficile; transmission

Clostridium difficile is the most common cause of healthcare-associated infections (HAIs) in the US, causing at least 450,000 infections and 29,000 associated deaths per year. Current C. difficile infection (CDI) prevention strategies have not decreased CDI. These strategies focus on preventing C. difficile transmission only from patients with symptomatic CDI, and ignore the much more common asymptomatic C. difficile carriers. Asymptomatic C. difficile carriers contaminate the hospital environment, transfer C. difficile spores to healthcare workers hands, and introduce strains associated with subsequent CDI cases. In addition, recent studies suggest at least 30% to 50% of new CDI cases are a result of transmission from asymptomatic C. difficile carriers. However, the potential impact of interventions directed at asymptomatic C. difficile carriers has not been adequately studied. One such strategy to prevent C. difficile transmission among hospitalized patients would be the use of gowns and gloves (contact precautions) for patients asymptomatically colonized with C. difficile. Identifying reductions in C. difficile transmission from asymptomatic carriers with contact precautions would change the paradigm of C. difficile prevention. We hypothesize that patients asymptomatically colonized with C. difficile are important for transmission in the hospital, and use of contact precautions for these patients will lead to decrease in patient-to-patient transmission of C. difficile. The study design is a retrospective analysis of stored specimens that were obtained from a 20 hospital cluster- randomized trial. Aim 1 will assess whether wearing gloves and gowns for all patient contact decreases acquisition of and infection with C. difficile. Aim 2 will assess the relative importance of colonization pressure with C. difficile on C. difficile transmission, and Aim 3 will determine if the NAP-1/027 strain is more transmissible than other strains. This innovative approach will develop the first randomized trial level data to guide C. difficile infection prevention and will inform science on the importance of individuals asymptomatically colonized with NAP-1/027 or other C. difficile strains. This proposal will go beyond the original cluster trial in Aim 1 to assess key questions of colonization pressure, contact precautions and NAP-1/027 on C. difficile transmission.

艰难梭菌是美国与医疗相关感染（HAI）的最常见原因，导致 每年至少450,000次感染和29,000例相关死亡。当前的艰难梭菌感染（CDI）预防 策略尚未减少CDI。这些策略专注于防止艰难梭菌传播 有症状的CDI患者，忽略了更常见的无症状艰难梭菌载体。 无症状的艰难梭菌载体污染了医院环境，将艰难梭菌孢子转移到 医护人员的手，并引入与随后的CDI病例相关的菌株。此外，最近 研究表明，至少30％至50％的新CDI病例是无症状C传播的结果。 艰难的载体。但是，针对无症状艰难梭菌载体的干预措施的潜在影响具有 没有得到充分的研究。防止住院艰难梭菌传播的一种策略 患者将是无效地定殖的患者的礼服和手套（接触预防措施） 艰难梭菌。识别与接触无症状载体的艰难梭菌传播的减少 预防措施将改变预防艰难梭菌的范式。我们假设患者 无疑用艰难梭菌殖民对于医院的传播很重要，并且使用接触很重要 这些患者的预防措施将导致艰难梭菌患者到患者的传播减少。研究 设计是对从20个医院簇获得的存储标本的回顾性分析。 随机试验。 AIM 1将评估所有患者接触的手套和礼服是否会减少 用艰难梭菌的获取和感染。 AIM 2将评估定殖压力的相对重要性 艰难梭菌在艰难梭菌的传播上，AIM 3将确定NAP-1/027应变是否更多 比其他菌株可传播。这种创新的方法将开发第一个随机试验级别数据 指导艰难梭菌感染的预防，并将科学无知的个人的重要性。 用NAP-1/027或其他艰难梭菌菌株定植。该建议将超越原始集群试验 目标1评估殖民压力，接触预防措施和艰难梭菌的NAP-1/027的关键问题 传播。