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

摘要 华盛顿大学（WU）/ BJC预防中心（PE）与CDC和其他 PE进行研究并将发现转化为新的策略，以预防与医疗保健相关的 感染（HAI）和抗菌素耐药性（AR）。WU/BJC PE被广泛认可为HAI & AR研究 &领导力。WU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实践。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个郊区和农村医院。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、微生物组和代谢方面专业知识的团队， 在不同的环境中研究HAI和AR。我们制定了一个具有高影响力的5年期提案，其中包含新的战略，以： 评估和预测不适当的抗菌药物使用和AR区域和国家;减少手术部位感染; 测试改善门诊抗生素处方的新举措;确定宏基因组学和代谢物差异 医院与社区之间的联系C.艰难梭菌;减少医院中的AR微生物储存库。 为实现这些目标，我们提出以下具体目标： 目的1A：评价抗菌药物在社区获得性肺炎中的使用、有效性和安全性 (CAP)国家行政数据。 目的1 B：建立革兰阴性杆菌脓毒症的聚集性耐药指标 (GNB)使用BJC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 关注感染结果。 目的3A：管理倡议，以限制乳腺切除术后出院后预防性抗生素的使用。 目标3 B：改善辅助生活中UTI老年患者的抗菌药物管理实践 设施 目的4：确定粪便微生物组和社区相关（CA）C的代谢物标志物。艰难 定植和感染（CDI）。 目的5：确定临床ICU环境中抗生素耐药微生物（ARO）的患病率， ARO与ICU临床培养分离株的关系，并测量环境卫生的影响 对ICU水槽排水管、周围环境和生物气溶胶中ARO浓度的干预。 我们还提交了3个提案，以领导小型，中型和大型多中心合作项目， 杜克大学、宾夕法尼亚大学、赫克顿/拉什大学、马里兰州大学和爱荷华州的PE作为潜在的参与者。

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.