Epidemiology of resistant bacteria in acute-care and long-term care facilities

描述(由申请人提供)：抗生素耐药性是一个日益严重的公共卫生问题，与相当大的发病率、死亡率和成本有关。鉴于抗生素发现速度的放缓和人口结构向日益老龄化的人口转变的临近，医院和长期护理机构(LTCFs)的老年人口对抗生素的耐药性是一场迫在眉睫的公共卫生灾难。我的长期职业目标是帮助减少医院和长期合作伙伴对抗生素耐药感染的发生率。这个应用程序的目的是为我提供在老年医学、数学建模和传染病方面的具体培训机会，以帮助我发展成为一名具有老年医学专业知识的传染病流行病学家。这项研究计划旨在提供这些机会，并将使用多学科方法来评估与耐甲氧西林金黄色葡萄球菌(MRSA)在医院和LTCFs中定植有关的三个假说。耐甲氧西林金黄色葡萄球菌(MRSA)是最常见的耐药细菌之一，也是医院内流行的病原菌。适当地了解和量化抗生素使用、患者流动和MRSA患者定植之间的关系是必要的，以便优化现有的感染控制努力，并确定控制这些病原体的更多机会。因此，我的长期目标和这个项目的目标与NlAID试图了解并最终预防威胁数百万人生命的传染病的使命是一致的。这项拟议的研究将利用四个长期护理中心两年一次的入院和两年一次的时点流行率研究，长期长期保健中心居民的预期队列，以评估入院时MRSA的流行率和与MRSA殖民相关的结果，以及评估设施间患者流动对MRSA流行率的相对贡献，以及针对最近转移的患者的感染控制干预措施在减少MRSA传播方面的有效性和成本效益。这些数据对于预防MRSA和其他潜在的耐药细菌的感染是不可或缺的。

DESCRIPTION (provided by applicant): Antibiotic resistance is an increasing public health problem that is associated with considerable morbidity, mortality and costs. Given the reduced pace of antibiotic discovery and the approaching demographic shift towards an increasingly aged population, antibiotic resistance among the geriatric population in both hospitals and long-term care facilities (LTCFs) represents an impending public health disaster. My long-term career goal is to help reduce the incidence of antibiotic-resistant infections in both hospitals and LTCFs. The purpose of this application is to provide me with opportunities for specific training in geriatric medicine, mathematical modeling, and infectious diseases to assist in my development into an infectious disease epidemiologist with expertise in geriatric medicine. This research plan is designed to provide these opportunities and will use a multi-disciplinary approach to assess three hypotheses related to colonization by methicillin-resistant Staphylococcus aureus (MRSA) in hospitals and LTCFs. MRSA is one of the most common antibiotic-resistant bacteria and a prevalent nosocomial pathogen. Appropriate understanding and quantification of the association between antibiotic use, patient movement, and colonization of patients with MRSA are necessary in order to optimize existing infection control efforts and to identify additional opportunities for control of these pathogens. Thus, my long- term goal and the goals of this project are consistent with the mission of NlAID in attempting to understand and ultimately prevent infectious diseases that threaten millions of human lives. The proposed study will utilize admission and biannual point prevalence studies at four LTCFs over two years, a prospective cohort of LTCF residents to assess both the prevalence of MRSA upon admission to acute care hospitals and outcomes associated with colonization by MRSA, and mathematical models to assess relative contributions of inter-facility patient movement on MRSA prevalence as well as the effectiveness and cost-effectiveness of infection control interventions targeting recently transferred patients in reducing the transmission of MRSA. These data are integral to the prevention of infections by MRSA and potentially other antibiotic-resistant bacteria.