MRSA in Children: Epidemiology, Pathogenesis, and Prevention

描述(由申请人提供)：这项K23奖项将为Aaron Milstone医学博士提供必要的资源和受保护的时间，使其成为一名进行以患者为中心的研究的独立调查员。除了研究研究，这项提案还概述了一个全面的职业发展计划，包括流行病学、生物统计学和临床试验方法方面的高级课程，以及来自医疗保健流行病学全国领先者的指导，以及一个教员咨询委员会。该奖项的研究部分将集中在儿童中的耐甲氧西林金黄色葡萄球菌(MRSA)，重点是社区相关的MRSA(CA-MRSA)菌株。由于CA-MRSA菌株助长了MRSA流行，因此MRSA的影响和控制需要进一步研究。CA-MRSA菌株正在进入医院，传播给儿童，并导致医院获得性感染和医院暴发。儿童耐甲氧西林金黄色葡萄球菌感染的临床谱被很好地描述。然而，耐甲氧西林金黄色葡萄球菌在儿童中定植和传播的流行病学和影响还没有得到很好的描述。此外，CA-MRSA菌株的毒力和传播性尚不清楚。儿科重症监护病房(PICU)为研究耐甲氧西林金黄色葡萄球菌(MRSA)的流行病学、发病机制和预防提供了可改善的环境。拟议的研究将1)测量MRSA在儿童人群中的定殖率和MRSA传播的发生率，并确定各种MRSA菌株的分布；2)确定被不同MRSA菌株定植的儿童感染MRSA的风险；3)评估每天用洗必泰洗澡患者的疗效，以此作为减少MRSA传播的可行策略。这些研究将利用约翰霍普金斯医院医院流行病学部和临床微生物学实验室的资源。我们预计这些研究将成为评估耐多药细菌在儿科人群中的影响的模式，并有助于指导资源分配用于住院儿童的感染预防策略。未来的研究将使用细菌分离株的档案及其相关的临床数据来进一步表征各种MRSA菌株的致病性。相关性：耐甲氧西林金黄色葡萄球菌是美国和世界各地疾病和死亡的重要原因。由于成人研究表明与MRSA相关的财务成本和死亡率增加，因此MRSA在儿童中的流行病学和影响需要进一步研究。需要健全的流行病学调查和创新可行的干预措施，以控制MRSA的传播和预防MRSA疾病。

DESCRIPTION (provided by applicant): This K23 award will provide Aaron Milstone, MD with the necessary resources and protected time to become an independent investigator performing patient-oriented research. In addition to the research studies, this proposal outlines a comprehensive career development program, including advanced coursework in epidemiology, biostatistics, and clinical trial methods and mentorship from a national leader in healthcare epidemiology in combination with a faculty advisory committee. The research component of this award will focus on methicillin-resistant Staphylococcus aureus (MRSA) in children with an emphasis on community-associated MRSA (CA-MRSA) strains. As CA-MRSA strains fuel an MRSA epidemic, the impact and control of MRSA requires further study. CA-MRSA strains are entering the hospital, being spread to children, and causing hospital-acquired infections and hospital outbreaks. The clinical spectrum of MRSA infection in children is well described. However, the epidemiology and impact of MRSA colonization and transmission in children is not well characterized. In addition, the virulence and transmissibility of CA-MRSA strains remains unclear. The pediatric intensive care unit (PICU) provides an environment amendable to studying the epidemiology, pathogenesis and prevention of MRSA. The proposed studies will 1) measure the prevalence of MRSA colonization and the incidence of MRSA transmission in a pediatric population and determine the distribution of various MRSA strains; 2) determine the risk of MRSA infection in children colonized with different MRSA strains; and 3) assess the efficacy of bathing patients daily with chlorhexidine as a feasible strategy to reduce MRSA transmission. These studies will utilize the resources of The Johns Hopkins Hospital Department of Hospital Epidemiology and the Clinical Microbiology Laboratory. We anticipate that these studies will serve as a model for assessing the impact of multidrug-resistant bacteria in a pediatric population, and help guide the allocation of resources towards infection prevention strategies in hospitalized children. Future studies will use the archive of bacterial isolates and their associated clinical data to further characterize the pathogenicity of various MRSA strains. RELEVANCE: MRSA is a significant cause of disease and death in the United States and around the world. Because studies in adults show increased financial costs and mortality associated with MRSA, the epidemiology and impact of MRSA in children requires further study. Sound epidemiologic investigation and innovative and feasible interventions are needed to control MRSA transmission and prevent MRSA disease.