Community-onset urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in women of diverse backgrounds

不同背景女性中产超广谱 β-内酰胺酶大肠杆菌引起的社区发病尿路感染

• 批准号: 10532721
• 负责人: Eva Raphael
• 金额: $ 20.12万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-01 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10532721
• 关键词: Address; Affect; Age; Antibiotics; Antimicrobial Resistance; Antimicrobial susceptibility; Award; Behavior; Benign; California; Case/Control Studies; Characteristics; Clinical; Clinical Management; Clinical Research; Communicable Diseases; Communities; Data; Data Collection; Diagnosis; Diet; Disease Outbreaks; Electronic Health Record; Epidemiologic Methods; Epidemiologist; Escherichia coli; Escherichia coli Infections; Ethnic Origin; Evaluation; Extended-spectrum β-lactamase; Family Practice; Food; Food Contamination; Future; Genitourinary system; Genotype; Geographic Distribution; Geography; Goals; Grant; Health; Healthcare; Healthcare Systems; Incidence; Income; Individual; Infection; Information Systems; International; Intestines; K-Series Research Career Programs; Longitudinal Studies; Mentors; Methods; Molecular Epidemiology; Neighborhoods; Organism; Outcome; Patient Outcomes Assessments; Patients; Phenotype; Population Heterogeneity; Positioning Attribute; Predisposition; Prevalence; Prevention; Prevention strategy; Probability; Process; Public Health; Questionnaires; Race; Reporting; Research; Research Methodology; Research Personnel; Resistance; Risk; Risk Factors; Sampling; San Francisco; Scientific Advances and Accomplishments; Source; Training; Translating; Transportation; Travel; Universities; Urinary tract infection; Woman; Work; antimicrobial resistant infection; antimicrobial resistant pathogen; career; cohort; community setting; community transmission; community-level factor; design; experience; food consumption; health care availability; health care settings; health inequalities; improved; novel; older patient; older women; pathogen; pathogenic Escherichia coli; prevent; professor; programs; recurrent infection; safety net; skills; social; social epidemiology; social factors; spatial epidemiology; transmission process; trend

PROJECT SUMMARY This is an application for a Career Development Award for Dr. Eva Raphael, a clinical research fellow and future Assistant Professor at the University of California, San Francisco. Her career goal is to be a family medicine-trained clinician-researcher improving prevention and outcomes for community-onset antimicrobial resistant infections by combining epidemiological methods to identify novel risk factors that can be intervened upon. This award will provide her with the training and research experience to: (1) examine demographic and neighborhood-level risk factors for community-onset urinary tract infections (UTI) caused by ESBL-producing Escherichia coli (ESBL-UTI) among women; (2) identify complications for community-onset ESBL-UTI and associated risk factors; and (3) investigate whether the temporal and geographic trends in prevalence of community-onset ESBL-UTI correlate with trends in prevalence of predominant E. coli genotypes. To facilitate successful completion of these activities, Dr. Raphael has assembled an ideal mentoring team comprised of two co-primary mentors, Dr. Maria Glymour, an expert in social epidemiology methods and health inequities research, and Dr. Henry Chambers, an expert in clinical antimicrobial resistance research, and a co-mentor, Dr. Alison Huang, an expert in genitourinary health in older women and patient-reported outcomes. In addition, Dr. Raphael will have 2 advisors: Dr. Salma Shariff-Marco, an expert in spatial epidemiology and neighborhood effect on health outcomes, and Dr. Sara Tartof, an infectious disease epidemiologist who focuses on antimicrobial resistance. The prevalence of antimicrobial resistant infections is increasing worldwide, both in healthcare and community settings. While antibiotic use is a major driver for selection of antimicrobial resistant organisms, novel risk factors are beginning to be identified for transmission of such organisms, especially in diverse populations. Moreover, new evidence suggests antimicrobial resistant infections, particularly UTI, may occur as community outbreaks. Therefore, it is essential to further examine risk factors other than antibiotic use for UTI caused by antimicrobial-resistant E. coli, in particular ESBL-UTI, and whether they occur as outbreaks in diverse communities. Dr. Raphael will build on findings from prior work showing that prevalence of community- onset ESBL-UTI has increased in a San Francisco public safety-net healthcare system and differed by race/ethnicity and age. Dr. Raphael will employ causal inference methods to identify novel individual and neighborhood risk factors for ESBL-UTI compared to both non-ESBL antimicrobial resistant and susceptible UTI and their complications (Aims 1 and 2). Through spatial analyses, geographic clusters of predominant E. coli genotypes causing UTI, particularly ESBL-UTI, will be identified and compared to geographic distribution of ESBL-UTI phenotypes (Aim 3). This work will be the basis of an R01 proposal for a longitudinal study identifying multilevel risk factors and incidence of UTI recurrence and complications in a cohort of community- dwelling women diagnosed with UTI. Through a focused program of mentored training and coursework, the candidate will gain skills in: (1) social epidemiology methods; (2) spatial epidemiology; and (3) patient-reported outcomes research methods as they apply to community-onset infections. These skills will facilitate Dr. Raphael's transition to independence by uniquely positioning her to address multilevel factors to improve community-onset infections outcomes in diverse populations.

项目总结 这是为伊娃·拉斐尔博士申请职业发展奖的申请，她是一名临床研究员， 加州大学旧金山分校未来的助理教授。她的职业目标是成家 受过医学培训的临床医生和研究人员改善社区首发抗菌药物的预防和结果 通过结合流行病学方法来确定可以干预的新危险因素，从而产生抗药性感染 在那里。该奖项将为她提供培训和研究经验，以：(1)审查人口统计学和 产超广谱β-内酰胺酶所致社区尿路感染的社区危险因素 (2)确定社区发病的ESBL-UTI的并发症和 相关风险因素；以及(3)调查患病率的时间和地理趋势 社区发病的ESBL-UTI与主要的大肠埃希氏菌基因型的流行趋势相关。为了方便 成功完成这些活动后，拉斐尔博士组建了一个理想的指导团队，由以下人员组成 两位共同的小学导师，玛丽亚·格拉穆尔博士，社会流行病学方法和卫生不平等方面的专家 和亨利·钱伯斯博士，他是临床抗菌素耐药性研究的专家，也是共同导师， 老年女性的泌尿生殖健康和患者报告的结果方面的专家Alison Huang博士说。此外, 拉斐尔博士将有两名顾问：萨尔玛·沙里夫-马尔科博士，空间流行病学和邻里关系专家 和Sara Tartof博士，传染病流行病学家，专注于 抗菌素耐药性。 在世界范围内，抗菌素耐药性感染的流行率正在上升，无论是在医疗保健领域还是在 社区设置。虽然抗生素的使用是选择抗菌素耐药生物体的主要驱动因素， 新的危险因素开始被确定为这种生物的传播，特别是在不同的 人口。此外，新的证据表明，抗菌素耐药性感染，特别是尿路感染，可能发生为 社区暴发。因此，有必要进一步检查除抗生素使用外的尿路感染危险因素。 由耐药大肠杆菌，特别是ESBL-UTI引起的，以及它们是否以暴发形式在 多样化的社区。拉斐尔博士将以先前工作的发现为基础，表明社区- 在旧金山公共安全网医疗系统中，发病的ESBL-UTI有所增加，区别在于 种族/民族和年龄。拉斐尔博士将使用因果推理方法来识别新的个体和 ESBL-UTI与非ESBL耐药和易感人群的邻近危险因素比较 尿路感染及其并发症(目标1和2)。通过空间分析，优势种E。 将鉴定引起UTI的大肠杆菌基因型别，特别是ESBL-UTI，并与地理分布进行比较。 ESBL-UTI表型(目标3)。这项工作将成为R01纵向研究提案的基础 在社区队列中确定多水平危险因素和尿路感染复发和并发症发生率- 被诊断为尿路感染的住家妇女。 通过有针对性的辅导培训和课程安排，应聘者将获得以下技能：(1)社交 流行病学方法；(2)空间流行病学；以及(3)患者报告结果的研究方法 适用于社区感染。这些技能将促进拉斐尔博士向独立的过渡 她的独特定位是解决多层次因素，以改善社区感染结果 不同的人群。