CK20-004, WASHINGTON UNIVERSITY & BJC EPICENTER TO PREVENT HEALTHCARE ASSOCIATED INFECTIONS & ANTIBIOTIC RESISTANCE

摘要 华盛顿大学(吴)/北京预防中心(PE)与疾控中心和其他机构合作 PES将进行研究并将发现转化为新战略，以防止与医疗保健相关的 感染(HAI)和耐药性(AR)。WU/BJC PE在HAI和AR研究方面得到广泛认可 &领导力。吴拥有出色的研究基础设施。BJC是一个集成的医疗保健提供系统 拥有15家医院、长期护理设施和门诊诊所。BJC包括两家学术医院， 巴恩斯-犹太和圣路易斯儿童医院和13家郊区和乡村医院。我们组织了一项研究 拥有ID、流行病学、信息学、微生物学、重症监护、微生物组和新陈代谢方面的专业知识的团队 在不同的环境中研究HAI和AR。我们制定了一项具有高度影响力的5年计划，并采用了新的策略来： 评估和预测不适当的抗菌药物使用和AR，减少手术部位感染； 测试改善门诊抗生素处方的新举措；确定代谢组和代谢物的差异 在医院和社区相关的艰难梭菌之间；减少医院的AR生物库。 为实现这些目标，我们提出了以下具体目标： 目标1A：评估抗菌药在社区获得性肺炎中的使用、有效性和安全性 (CAP)具有国家行政数据。 目标1B：制定革兰氏阴性杆菌败血症的综合耐药措施 (GNB)使用北京赛马会电子健康记录数据。 目的2：现有麻醉控制塔(ACT)干预对改善术中效果的影响 对感染后果的关注。 目标3A：管理倡议，限制乳腺癌切除术后出院后预防性抗生素的使用。 目标3B：改善辅助生活中老年尿路感染患者的抗微生物管理实践 设施。 目的4：确定艰难梭菌群落相关(CA)的粪便微生物群和代谢物标志 移居和感染(CDI)。 目的5：确定抗生素耐药菌(ARO)在临床ICU环境中的流行率， 急性呼吸窘迫综合征与ICU临床分离株的关系及对环境卫生的影响 对ICU水槽排水口、周围环境和生物气溶胶中ARO浓度的干预。 我们还提交了3份提案，以领导大中小型多中心合作项目 杜克大学、宾夕法尼亚大学、Hektoen/Rush大学、马里兰大学和爱荷华州大学是潜在的参与者。

ABSTRACT The Washington University (WU) / BJC Prevention Epicenter (PE) works collaboratively with CDC & other PEs to perform research & translate discoveries into novel strategies to prevent healthcare-associated infections (HAI) & antimicrobial resistance (AR). The WU/BJC PE is widely recognized for HAI & AR research & leadership. WU has outstanding research infrastructure. BJC is an integrated healthcare delivery system with 15 hospitals, long-term care facilities, & outpatient practices. BJC includes two academic hospitals, Barnes-Jewish & St. Louis Children’s Hospitals & 13 suburban & rural hospitals. We organized a research team with expertise in ID, epidemiology, informatics, microbiology, critical care, microbiome, & metabolism to study HAI & AR in diverse settings. We developed a high impact 5-yr proposal with novel strategies to: Evaluate & predict inappropriate antimicrobial use & AR regionally & nationally; Reduce surgical site infections; Test novel initiatives to improve outpatient antibiotic prescribing; Identify metagenomic & metabolite differences between hospital & community associated C. difficile; Reduce AR organism reservoirs in hospitals. To achieve these goals, we propose the following Specific Aims: Aim 1 A: Evaluate the use, effectiveness, and safety of antimicrobials in community-acquired pneumonia (CAP) with national administrative data. Aim 1 B: Develop aggregate antimicrobial resistance measures in sepsis caused by Gram-negative bacilli (GNB) using BJC electronic health record data. Aim 2: The impact of an existing Anesthesia Control Tower (ACT) intervention to improve intraoperative care on infectious outcomes. Aim 3 A: Stewardship initiative to limit post-discharge prophylactic antibiotic use after mastectomy. Aim 3 B: Improve antimicrobial stewardship practices in elderly patients with UTIs in assisted living facilities. Aim 4: Identify fecal microbiome and metabolite markers of community associated (CA) C. difficile colonization and infection (CDI). Aim 5: Define the prevalence of antibiotic resistant organisms (ARO) in the clinical ICU environment, relationship of ARO to ICU clinical culture isolates and measure the impact of an environmental hygiene intervention on ARO concentration in ICU sink drains, the surrounding environment and bioaerosols. We are also submitting 3 proposals to lead Small, Medium & Large Multicenter Collaborative Projects with Duke, U Penn, Hektoen / Rush, University of Maryland, and Iowa PEs as potential participants.