Effectiveness of Treatment and Outcomes for Veterans Infected with Resistant Gram-negative Organisms.

感染耐药革兰氏阴性菌的退伍军人的治疗效果和结果。

• 批准号: 9502631
• 负责人: CHARLESNIKA T EVANS
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9502631
• 关键词: Accounting; Acinetobacter; Acinetobacter baumannii; Acute; Amputation; Antibiotic Resistance; Antibiotic Therapy; Antibiotic-resistant organism; Antibiotics; Bacteria; Bacterial Infections; Carbapenems; Caring; Categories; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical; Clinical Practice Guideline; Clostridium difficile; Combined Modality Therapy; Community Hospitals; Complex; Cost Effectiveness Analysis; Data; Data Sources; Databases; Development; Devices; Direct Costs; Drug resistance; Effectiveness; Electronic Health Record; Enterobacter; Enterobacteriaceae; Escherichia coli; Failure; Goals; Health system; Healthcare; Hospital Mortality; Hospitalization; Hospitals; Infection; Inpatients; Intervention; Klebsiella; Klebsiella pneumonia bacterium; Length of Stay; Medical; Meningitis; Microbiology; Morbidity - disease rate; Multi-Drug Resistance; Nosocomial Infections; Operative Surgical Procedures; Organism; Outcome; Outcome Study; Patient-Focused Outcomes; Patients; Pharmacy facility; Pneumonia; Population; Population Heterogeneity; Prevalence; Pseudomonas aeruginosa; Recommendation; Regimen; Research; Resistance; Risk; Risk Factors; Safety; Sepsis; Site; Spinal cord injury; Time; Treatment Effectiveness; Treatment Failure; Treatment Protocols; Treatment outcome; Veterans; Work; adverse outcome; antimicrobial; carbapenem resistance; carbapenem-resistant Enterobacteriaceae; care seeking; clinical practice; comparative; comparative effectiveness; compare effectiveness; complex chronic conditions; cost; effective therapy; effectiveness research; experience; health care settings; healthcare-associated infections; improved; innovation; methicillin resistant Staphylococcus aureus; mortality; multi-drug resistant pathogen; multidrug-resistant Pseudomonas aeruginosa; patient population; programs; transmission process; treatment guidelines; treatment strategy

Approximately 0.7 to 1.7 million health care-associated infections (HAIs) occur in the U.S. each year in inpatients receiving care in U.S. acute care community-hospital stays. Many of these infections are caused by antibiotic resistant organisms including multidrug resistant gram-negative organisms (MDRGNOs). One of the prime predictors of morbidity and mortality following infection with drug resistant organisms is inadequate empiric and definitive antibiotic treatment of the infection. Lack of specific clinical practice guidelines for treatment of these organisms increases the ambiguity of effective treatment strategies. It is unclear what treatment regimens are being used within VA for treatment of MDRGNOs nor how effective they are. Therefore, the goal of this study is to use national VA data to describe current treatment strategies for select MDRGNOs (Carbapenem Resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa, and Acinetobacter species) and the comparative effectiveness of these strategies on outcomes in Veterans. This study is highly relevant to patients seeking care in VA, as Veterans experience many of the risk factors associated with development of an MDRGNO infection. VA treats patients with serious complex conditions that require frequent hospitalization or contact with health care or use of invasive devices (i.e. spinal cord injury, amputations) that put them at risk for infections. MDRGNOS and inadequate treatment have a significant impact on morbidity and mortality outcomes in those with complex conditions. Also, the proposed research is related to the VA's Multidrug Resistant Organism (MDRO) Program that has developed and implemented national programs to reduce the transmission and spread of MRSA and Clostridium difficile. Our findings will produce effectiveness data on outcomes for MDRGNOs including CRE in a diverse population of Veterans that can be used by VA program offices for developing guidance for treatment. This research is innovative in that it will be the first study, to our knowledge, utilizing national VA microbiology, pharmacy, and medical encounter databases to answer comparative effectiveness research questions on effective treatment strategies for MDRGNOs. The long-term goal will be to develop actionable findings for decision makers that can be implemented to improve the effectiveness of treatment and healthcare of patients with MDRGNO infections across different populations.

美国每年发生约70万至170万例卫生保健相关感染（HAI）， 在美国急性护理社区医院接受护理的住院患者。许多感染是由 包括多重耐药革兰氏阴性菌（MDRGNO）在内的抗生素耐药微生物。一 耐药微生物感染后发病率和死亡率的主要预测因素是 感染的经验性和确定性抗生素治疗不足。缺乏具体的临床实践 这些生物体的治疗指南增加了有效治疗策略的模糊性。是 不清楚VA中使用何种治疗方案治疗MDRGNO，也不清楚其有效性 他们来了因此，本研究的目的是使用国家VA数据来描述当前的治疗策略 对于选择的MDRGNO（碳青霉烯耐药肠杆菌科（CRE）、铜绿假单胞菌，和 不动杆菌属）和这些策略对退伍军人结局的比较有效性。 这项研究与寻求VA护理的患者高度相关，因为退伍军人经历了许多风险因素 与MDRGNO感染的发展相关。VA治疗患有严重复杂疾病的患者 需要频繁住院或接触医疗保健或使用侵入性设备（即脊髓）的 受伤，截肢），使他们面临感染的风险。MDRGNOS和治疗不足， 对复杂疾病患者的发病率和死亡率结果有显著影响。此外，拟议的 研究与VA的多药耐药微生物（MDRO）计划有关，该计划已经开发并 实施国家计划，以减少MRSA和艰难梭菌的传播和蔓延。 我们的研究结果将产生MDRGNO结局的有效性数据，包括在不同的 退伍军人计划办公室可用于制定治疗指南的退伍军人群体。这 研究是创新的，因为它将是第一项研究，据我们所知，利用国家VA微生物学， 药学和医疗遭遇数据库，以回答比较有效性研究问题， MDRGNO的有效治疗策略。长期目标将是制定可采取行动的调查结果， 决策者，可以实施，以提高治疗和保健的有效性， 不同人群中MDRGNO感染的患者。