The INFECTADO study: INFECTions Acquired by persons on maintenance hemoDialysis during hOspitalizations

INFECTADO 研究：住院期间接受维持性血液透析的人获得的感染

• 批准号: 10731626
• 负责人: ERIKA M D'AGATA
• 金额: $ 50万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10731626
• 关键词: INFECTADO; study; INFECTions; Acquired; persons

ABSTRACT More than 500,000 persons require maintenance hemodialysis (pMHD) per year in the United States, disproportionately affecting persons who are Black or Hispanic. pMHD are an Agency of Healthcare Research and Quality priority population. Infections are the second most common cause of mortality among pMHD due to a uremia-induced immunocompromised state and multiple co-morbidities. pMHD are also at substantial risk of hospital-acquired infections (HAI) as they are admitted to the hospital on average twice per year. Compared to the general hospitalized population, pMHD have a 2.4-fold higher risk of developing an HAI. There is a tremendous paucity of data pertaining to the epidemiology of HAI among pMHD, including potential racial and ethnic disparities. In this proposal, entitled “The INFECTADO study: INFECTions Acquired by persons on maintenance hemoDialysis during hOspitalizations”, we will quantify and characterize the epidemiology of HAI among pMHD. This proposal will therefore generate important information as how to best improve current prevention strategies aimed at reducing HAI in pMHD. Under aims 1 and 2, we will use the Unites States Renal Data System (USRDS), a nationwide-Medicare database, to analyze prevalence, risk factors and outcomes of HAI over an 8-year study period (~360,000 pMHD per year). Analyses will also focus on MHD modality type, race/ethnicity and social determinants of health. Under aim 3, we will use the Centers for Disease Control and Prevention’s National Healthcare Safety Network-based active surveillance data from 31 hospitals within the University of Pittsburgh Medical Center hospital network over an 8-year period (~4,777 pMHD per year), to further characterize HAI epidemiology, including causative pathogens and antimicrobial resistance profiles. By using two different data sources, a complete characterization of HAI epidemiology among pMHD will be obtained, since each data source provides supplementary data, as outlined in the proposal. The interdisciplinary team is comprised of investigators who have produced an abundance of scholarly end-stage renal disease research efforts over the last 2-decades and have expertise in infections among pMHD, data analyses using the USRDS and HAI active surveillance methodologies. A summary of specific aims are 1] Aims 1 and 2: To quantify and characterize HAI prevalence, risk factors and outcomes among all pMHD with and without HAI, and between: a] in-center vs home MHD, b] Black persons vs persons of other races on MHD and c] Hispanic vs non-Hispanic persons on MHD, using the USRDS database and 2] Aim 3: To quantify and characterize HAI epidemiology among pMHD with an HAI compared to hospitalized persons with an HAI, including causative pathogens and antimicrobial resistance profiles, using active infection surveillance. This proposal will result in an increased understanding of HAI epidemiology among the high-risk group of pMHD and health disparities within this population, and will provide important information to guide future prevention strategies aimed at reducing HAI and improving patient outcomes.

抽象的 在美国每年有超过 500,000 人需要维持性血液透析 (pMHD)， 对黑人或西班牙裔的影响尤为严重。 pMHD 是医疗保健研究机构 和质量优先人口。感染是导致 pMHD 死亡的第二大常见原因，原因是 尿毒症引起的免疫功能低下状态和多种并发症。 pMHD 也面临着巨大的风险 医院获得性感染 (HAI)，因为他们平均每年入院两次。相比 与一般住院人群相比，pMHD 发生 HAI 的风险高出 2.4 倍。有一个 有关 pMHD 中 HAI 流行病学的数据极其缺乏，包括潜在的种族和 种族差异。在这项题为“INFECTADO 研究：感染者获得的感染”的提案中， 住院期间的维持性血液透析”，我们将量化和描述 HAI 的流行病学 在 pMHD 中。因此，该提案将产生重要信息，例如如何最好地改进当前的 旨在减少 PMHD 中 HAI 的预防策略。根据目标 1 和 2，我们将使用美国肾 数据系统 (USRDS)，一个全国性的医疗保险数据库，用于分析患病率、风险因素和结果 8 年研究期间的 HAI（每年约 360,000 个 pMHD）。分析还将重点关注 MHD 模式类型， 种族/民族和健康的社会决定因素。根据目标 3，我们将利用疾病控制中心和 预防国家医疗安全网络基于来自 31 家医院的主动监测数据 匹兹堡大学医学中心医院网络在 8 年期间（每年约 4,777 个 pMHD）， 进一步描述 HAI 流行病学特征，包括致病病原体和抗菌药物耐药性概况。经过 使用两个不同的数据源，将获得 pMHD 中 HAI 流行病学的完整特征， 因为每个数据源都提供补充数据，如提案中所述。跨学科团队是 由进行了大量终末期肾病学术研究的研究人员组成 过去 20 年的努力，在 PMHD 感染方面拥有专业知识，使用 USRDS 进行数据分析 和 HAI 主动监测方法。具体目标总结为 1] 目标 1 和 2：量化和 描述所有患有和不患有 HAI 的 pMHD 之间的 HAI 患病率、危险因素和结果，以及：a] 中心内与家庭 MHD，b] 黑人与 MHD 上其他种族的人以及 c] 西班牙裔与非西班牙裔 接受 MHD 的人员，使用 USRDS 数据库和 2] 目标 3：量化和描述 HAI 流行病学 患有 HAI 的 pMHD 与患有 HAI 的住院患者相比，包括致病病原体和 抗菌药物耐药性概况，使用主动感染监测。该提案将导致增加 了解 pMHD 高危人群中 HAI 的流行病学以及其中的健康差异 人口，并将提供重要信息来指导旨在减少 HAI 的未来预防战略 并改善患者的治疗效果。