CK20-004, Duke-UNC Prevention Epicenter Program for Protecting Patients from Infections, Antibiotics Resistance and Other Adverse Events

CK20-004，杜克大学-北卡罗来纳大学预防震中计划，旨在保护患者免受感染、抗生素耐药性和其他不良事件的影响

• 批准号: 10650205
• 负责人: Deverick John Anderson
• 金额: $ 158.36万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650205
• 关键词: CK20; 004; Duke; UNC; Prevention

Project Summary Healthcare-associated infections (HAIs) and antimicrobial resistance (AR) lead to adverse patient outcomes, including increased mortality, morbidity, and length of hospitalization. While progress in prevention is occurring, innovative and improved strategies for prevention of HAIs, AR, and patient harm are needed. The overall objective of this proposal is to identify potential strategies to decrease HAIs and prevent AR emergence, transmission, and acquisition. Our Core Proposal includes 6 unique studies to address 4 specific lines of investigation (specific aims [SA]): environmental disinfection, antimicrobial stewardship, diagnostic stewardship, and community-acquired Clostridioides difficile infection (CA-CDI). These studies will 1) evaluate novel strategies to decrease environmental contamination with opportunistic premise plumbing pathogens related to hospital sinks using a) Pall filters and drain covers (SA1A) and b) engineered plasmids (SA1B); 2) identify and evaluate innovative antimicrobial stewardship (AS) interventions and metrics to decrease AR and patient harm a) at transitions of care (e.g., discharge) in community hospitals (SA2A) and b) related to post-operative antibiotics (SA2B); 3) develop and validate reflex urine culture criteria to guide improved utilization of urine cultures (SA3); and 4) evaluate and determine the contribution of environmental sources on acquisition and occurrence of CA-CDI (SA4). These studies involve patients admitted to community and academic hospitals as well as patients in the community setting. We will achieve this objective by using the strengths of a unique, innovative, and previously successful collaboration between investigators in the Duke Center for Antimicrobial Stewardship and Infection Prevention and the University of North Carolina at Chapel Hill. We will capitalize on programmatic strengths in both institutions: expertise in environmental disinfection, antimicrobial stewardship, infection prevention, AR, epidemiology, surveillance, and emerging infections; access to large and unique research networks and infrastructure; and proven success with collaborative research involving multiple institutions. All Core Projects proposed in this application represent early stage translational research (T0-T1) with clearly identified “next steps” that will help expedite identification and development of practices that effectively prevent HAIs and AR. In addition, we are proposing 3 Collaborative Projects with other CDC Prevention Epicenters Programs: 1) a cluster randomized non-inferiority crossover trial on the use of contact precautions for MRSA and VRE acquisition (Large); 2) evaluation of the feasibility and utility of robust antibiotic use risk-adjustment machine learning models (Medium); and 3) metagenomic evaluation to determine if and how often endogenous flora contaminate surgical wounds (Small). These studies involve patients admitted to community and academic hospitals. Overall, these studies exemplify our ongoing collaboration between scientists with expertise in T0 metagenomics, bioengineering, and microbiology and researchers with expertise in T1-T2 studies. The contribution of these studies will be significant because they will lead to new strategies to prevent HAIs, AR, and patient harm, thereby improving the health and safety of the US population.

项目摘要 医疗保健相关感染（HAI）和抗菌素耐药性（AR）导致患者不良结局， 包括增加的死亡率、发病率和住院时间。虽然预防工作正在取得进展， 需要用于预防HAI、AR和患者伤害的创新和改进的策略。整体 本提案的目的是确定减少HAI和预防AR出现的潜在策略， 传输和获取。我们的核心提案包括6项独特的研究，以解决4个具体问题， 调查（特定目的[SA]）：环境消毒、抗菌剂管理、诊断管理， 社区获得性艰难梭菌感染（CA-CDI）。这些研究将1）评价新的 减少机会性房屋管道病原体对环境污染的战略， 使用a）Pall过滤器和排水盖（SA 1A）和B）工程质粒（SA 1 B）的医院水槽; 2）鉴定和 评估创新的抗菌管理（AS）干预措施和指标，以减少AR和患者伤害 a）在护理过渡期（例如，出院）在社区医院（SA 2A）和B）有关的术后 抗生素（SA 2B）; 3）制定和验证反射尿培养标准，以指导改善尿液利用 文化（SA 3）; 4）评估和确定环境来源对收购的贡献， 发生CA-CDI（SA 4）。这些研究涉及社区和学术医院收治的患者， 以及社区环境中的患者。我们将利用一个独特的， 杜克抗菌药物研究中心的研究人员之间的创新和先前成功的合作 管理和感染预防和北卡罗来纳州大学在查佩尔山。我们将利用 这两个机构的计划优势：环境消毒，抗菌管理， 感染预防、AR、流行病学、监测和新发感染;获得大型和独特的 研究网络和基础设施;并证明成功的合作研究，涉及多个 机构职能体系本申请中提出的所有核心项目均代表早期转化研究（T0-T1） 明确确定的“下一步”，将有助于加快确定和发展的做法， 有效预防HAI和AR。此外，我们还与其他CDC提出了3个合作项目 预防中心计划：1）一项关于使用接触的整群随机非劣效性交叉试验 MRSA和VRE采集的注意事项（大）; 2）评价强效抗生素的可行性和效用 使用风险调整机器学习模型（中等）; 3）宏基因组评估，以确定是否以及如何 通常内源性植物群污染手术伤口（Small）。这些研究涉及入院的患者 社区和学术医院。总的来说，这些研究支持我们正在进行的合作， 具有T0宏基因组学、生物工程和微生物学专业知识的科学家，以及具有 在T1-T2研究中。这些研究的贡献将是重大的，因为它们将导致新的战略， 预防HAI、AR和患者伤害，从而改善美国人口的健康和安全。