Antibiotic use and bacteriuria in the rural nursing home

描述（由申请方提供）：本提案的目标是通过解决日益严重的抗生素耐药性和抗生素使用不当问题，改善犹他州农村地区疗养院（NH）居民的护理和安全。疗养院大量使用抗生素，这种水平的抗生素使用所施加的选择压力，特别是在密闭环境中，是巨大的。毫不奇怪，NH中的抗生素耐药性和感染耐药性微生物的风险正在上升。在老年居民感染风险已经显著增加的临床环境中，这一点尤其令人担忧。 这项工作的重点将是革兰氏阴性泌尿系分离株的抗生素耐药性，以及在农村NH环境中导管相关菌尿和尿路感染（UTI）的管理。据推测，抗生素耐药性和不适当的抗生素使用的问题是相当大的农村卫生机构，在那里很少有人知道的管理做法和监测很少，如果在所有，进行。这些假设将通过两种方法进行研究。第一个项目将在整个犹他州农村地区的国家卫生机构采用基于个人数字助理（PDA）的监测工具，以跟踪革兰氏阴性泌尿系分离株的抗菌素耐药性，特别是那些长期插管的患者。第二项研究将使用类似的基于PDA的工具，前瞻性地评估来自犹他州农村NHS的长期导管插入患者的菌尿和UTI管理。这些研究将为第三个项目奠定基础，在该项目中，候选人将使用基于PDA的决策支持工具实施干预，以改善农村SNF居民的导管相关无症状菌尿和症状性尿路感染的管理，强调其对患者护理，患者安全和总体成本的影响。 该项目是观察和干预流行病学与医学信息学工具和技术的理想结合，将其应用于NH环境中抗生素使用和耐药性的巨大临床问题。犹他州大学的NIH资助的K30项目，沿着杰出的导师和研究小组，将为掌握这些技术以及最大限度地发挥该项目和该候选人的潜力提供一流的教育和研究环境。

DESCRIPTION (provided by the applicant): The goal of this proposal is to improve the care and safety of residents of nursing homes (NHs) in rural areas of Utah by addressing the growing problem of antibiotic resistance and inappropriate antibiotic use in this setting. Antibiotics are heavily used in nursing homes, and the selection pressure exerted by this level of antibiotic use, particularly in a contained environment, is enormous. Not surprisingly, antibiotic resistance in NHs and the risk of infection with an antibiotic-resistant organism are rising. This is of particular concern in a clinical setting where elderly residents already have a significantly increased risk of infection. The focus of this work will be antibiotic resistance among gram-negative urinary isolates and the management of catheter-associated bacteriuria and urinary tract infections (UTI) in the rural NH setting. It is hypothesized that the problems of antibiotic resistance and inappropriate antibiotic use are considerable in rural NHs, where little is known about management practices and surveillance is rarely, if at all, performed. These hypotheses will be investigated by two approaches. The first will employ a personal digital assistant (PDA)-based surveillance tool at NHs throughout rural Utah to track antimicrobial resistance among gram-negative urinary isolates, particularly those from long-term catheterized patients. The second will use a similar PDA-based tool to prospectively assess management of bacteriuria and UTI in long-term catheterized patients from rural Utah NHs. These studies will lay the groundwork for a third project, where the candidate will implement an intervention using a PDA-based decision-support tool to improve the management of catheter-associated asymptomatic bacteriuria and symptomatic urinary tract infection for residents of rural SNFs, emphasizing its impact on patient care, patient safety, and overall costs. This project is an ideal blend of observational and interventional epidemiology with the tools and techniques of medical informatics, applying them to the enormous clinical problem of antibiotic use and resistance in the NH setting. The NIH-funded K30 program at the University of Utah, along with the outstanding mentorship and research group assembled, will provide a superb educational and research environment for the mastering of these techniques as well as for maximizing the potential of this project and this candidate.