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: 9262851
• 负责人: AARON M MILSTONE
• 金额: $ 42.18万
• 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 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9262851
• 关键词: Decreasing; Neonatal; Staphylococcus; aureus; Disease

DESCRIPTION (provided by applicant): 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.

描述(申请人提供)：在美国，每年有近50万名婴儿早产。早产是导致儿童长期神经残疾的主要原因，每年造成的损失超过260亿美元。早产儿在新生儿重症监护病房(NICU)接受护理，在那里有33,000多名婴儿患上医疗保健相关感染(HAI)。据估计，HAI每年导致280亿至450亿美元的医疗成本。除了人类免疫缺陷病毒的短期成本外，新生儿感染还会造成毁灭性的神经功能障碍 以及糟糕的增长结果。金黄色葡萄球菌(S.aureus)是引起新生儿HAIS的第二大常见病原体。在57,000名极低出生体重儿中，估计有3.7%的婴儿每年发生血液或中枢神经系统金黄色葡萄球菌感染，可归因性死亡率为25%。尽管采取了积极的措施预防新生儿感染金黄色葡萄球菌，但金黄色葡萄球菌病在这一人群中的负担仍然很高。我们提出了一种新的模式来预防新生儿金黄色葡萄球菌感染。父母，而不是医护人员，可能是新生儿在NICU获得金黄色葡萄球菌定植的关键来源。这一发现与不断变化的NICU环境相一致，在NICU环境中，鼓励父母和新生儿之间的皮肤接触，并可能促进金黄色葡萄球菌的传播，同时，常见的医院感染预防措施减少了医护人员对金黄色葡萄球菌的传播。这项建议的长期目标是预防新生儿中的禽流感，特别是那些引起金黄色葡萄球菌的感染。其具体目的是：1)评估新生儿重症监护室父母和新生儿中金黄色葡萄球菌的定植和菌株一致性；目的2)在随机对照试验中，测量父母使用短程莫匹罗星和外用洗必泰消毒剂治疗对新生儿金黄色葡萄球菌定植的影响。我们将收集NICU入院的新生儿及其父母的队列，并对他们进行纵向跟踪，以衡量NICU新生儿中金黄色葡萄球菌的定植情况，并确定父母在出生后金黄色葡萄球菌传播中的作用。一些新生儿-父母配对将被随机分配，父母将接受治疗或控制以根除金黄色葡萄球菌的定植。这项提案的发现可能会改变NICU预防HAI的范式，从专注于医护人员和环境的范式转变为认识到父母和来访者是导致HAI的病原体的重要接触来源。

项目成果

Expanding the statistical toolbox: analytic approaches for cohort studies with healthcare-associated infectious outcomes.

扩展统计工具箱：针对与医疗保健相关的感染结果的队列研究的分析方法。

• DOI: 10.1097/qco.0000000000000179
• 发表时间: 2015
• 期刊: Current opinion in infectious diseases
• 影响因子: 3.9
• 作者: Pierce,RebeccaA;Lessler,Justin;Milstone,AaronM
• 通讯作者: Milstone,AaronM

Analysis of Morphologically Similar Staphylococcus aureus Colonies for Assessment of Phenotypic and Genotypic Correlation.

分析形态相似的金黄色葡萄球菌菌落以评估表型和基因型相关性。

• DOI: 10.1128/jcm.00402-17
• 发表时间: 2017
• 期刊: Journal of clinical microbiology
• 影响因子: 9.4
• 作者: Totten,Marissa;Ross,Tracy;Voskertchian,Annie;Colantuoni,Elizabeth;Milstone,AaronM;Carroll,KarenC
• 通讯作者: Carroll,KarenC

Bacterial Infections in Neonates Following Mupirocin-Based MRSA Decolonization: A Multicenter Cohort Study.

基于穆匹洛罗金的MRSA非殖民化后，新生儿的细菌感染：一项多中心队列研究。

• DOI: 10.1017/ice.2017.108
• 发表时间: 2017-08
• 期刊: Infection control and hospital epidemiology
• 影响因子: 4.5
• 作者: Pierce R;Bryant K;Elward A;Lessler J;Milstone AM
• 通讯作者: Milstone AM

Manipulating the microbiome: evolution of a strategy to prevent S. aureus disease in children.

• DOI: 10.1038/jp.2017.155
• 发表时间: 2018-03
• 期刊: Journal of perinatology : official journal of the California Perinatal Association
• 作者: Khamash DF;Voskertchian A;Milstone AM
• 通讯作者: Milstone AM

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Quasi-Experimental Designs.

• DOI: 10.1017/ice.2016.117
• 发表时间: 2016-10
• 期刊: INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
• 影响因子: 4.5
• 作者: Schweizer, Marin L.;Braun, Barbara I.;Milstone, Aaron M.
• 通讯作者: Milstone, Aaron M.