Endemic and Emerging Multidrug Resistant Organisms in Nursing Homes: A Neglected Clinical Setting

项目摘要/摘要 在养老院接受护理的个人不成比例地经历不良后果，原因是 具有多重抗药性的生物。这项调查将集中在一种地方性和致命的病原体上，这种病原体与 疗养院-耐甲氧西林金黄色葡萄球菌(MRSA)和一种高度新兴的抗生素 耐药真菌--金黄色念珠菌，这两种真菌在美国都与大量的发病率和死亡率有关。 养老院。虽然耐甲氧西林金黄色葡萄球菌一直是医院的主要预防目标，但几乎没有采取什么措施来解决 这种病原体在疗养院中存在，尽管疗养院的MRSA流行率是疗养院的3倍 比医院和疗养院的MRSA携带者每年有40%的感染风险。 由MRSA引起的疗养院风险现在因金黄色葡萄球菌而变得更加复杂，这种细菌被称为 “真菌耐甲氧西林金黄色葡萄球菌”由于相似的传播特征，包括显著的定植倾向 身体，并在表面上停留较长时间。C.Auris一直与难以治愈的疫情有关 高可归因性死亡率的疗养院；5%-10%的已知携带者患侵袭性感染，30%- 因此，60%的侵袭性感染患者死亡。因此，确定哪些疗养院居民在 MRSA和金黄色葡萄球菌携带的最大风险是有效应对和控制的关键。 这项提议总体目标是产生关于MRSA和C.Auris运输的新数据，以及 疗养院的污染为控制这些重要病原体提供了干预措施。第一 目的确定疗养院设施特征和与MRSA相关的居民危险因素。 C.Auris马车。这一目标的结果可以针对高危居民进行筛查和预防 活动。第二个目标是确定MRSA的高接触性护理活动(例如，穿衣、洗澡) 以及金黄色葡萄球菌携带者会在其周围环境中造成高接触物体的污染。如果是这样，专注于 活动后清洁对于减少MRSA和金黄色葡萄球菌污染和减少传播可能很重要。 我(加布里埃尔·古辛，硕士)正在加州大学欧文分校攻读公共卫生博士学位。这 F31奖学金将使我能够将我以前在系统生物学方面的硕士培训与 流行病学、临床研究和人口健康。我将得到一个多学科团队的指导， 在临床传染病、流行病学、多重耐药生物、公共卫生、护理方面的专业知识 家庭手术和生物统计学来支持我提出的目标和职业目标。

Project Summary/Abstract Individuals receiving care in nursing homes disproportionally experience adverse outcomes due to multidrug-resistant organisms. This investigation will focus on an endemic and virulent pathogen common to nursing homes – methicillin-resistant Staphylococcus aureus (MRSA), and a highly emerging antibiotic resistant fungus – Candida auris, both of which have been linked to substantial morbidity and mortality in U.S. nursing homes. While MRSA has been a major prevention target in hospitals, little has been done to address this pathogen in nursing homes despite the fact that nursing homes have a 3-fold higher MRSA prevalence than hospitals and MRSA carriers in nursing homes have a 40% risk of infection per year. Risk in nursing homes due to MRSA is now compounded by C. auris, which has been termed the “fungal MRSA” due to similar transmission characteristics, including a remarkable propensity to colonize the body and persist on surfaces for prolonged periods. C. auris has been associated with intractable outbreaks in nursing homes with high attributable mortality; 5-10% of known carriers develop invasive infections and 30- 60% of those with invasive infection die as a result. Thus, determining which nursing home residents are at greatest risk for MRSA and C. auris carriage is crucial for effective response and control. The overall goal of this proposal is to generate novel data on MRSA and C. auris carriage and contamination in nursing homes to inform interventions to control these important pathogens. The first objective is to identify nursing home facility characteristics and resident risk factors associated with MRSA and C. auris carriage. Results from this objective could target high-risk residents for screening and prevention activities. The second objective is to determine if high-contact care activities (e.g., dressing, bathing) for MRSA and C. auris carriers cause contamination of high-touch objects in their immediate environment. If so, focused post-activity cleaning could be important to reduce MRSA and C. auris contamination and mitigate spread. I (Gabrielle Gussin, MS) am pursuing a Ph.D. in Public Health at the University of California, Irvine. This F31 fellowship will enable me to bridge my previous Master’s training in Systems Biology with skills in epidemiology, clinical research, and population health. I will be mentored by a multidisciplinary team with expertise in clinical infectious diseases, epidemiology, multidrug-resistant organisms, public health, nursing home operations, and biostatistics to support my proposed aims and career goals.