Modeling of S. aureus Transmission in Northern Manhattan.

对抗生素具有抗药性的金黄色葡萄球菌感染现在社区中越来越多。这些 社区感染，特别是由耐甲氧西林金黄色葡萄球菌(MRSA)引起的感染 没有常见危险因素的组。对这些菌株是如何传播和传播的了解很少 随后在社区内建立起来。如果要采取干预措施，这仍然是一个关键问题 旨在防止社区相关(CA)-MRSA分离株在人口水平上的传播。本研究 将回答以下问题。1.什么压力是CA-MRSA传播途径的原因 在社区内？CA-MRSA在哥伦比亚大学医学中心的传播模式 将确定主要服务不足的移民人口的集水区。这项研究将使用 回顾性病例对照研究设计。有记录的CA-MRSA感染和社区的索引病例 匹配的索引控制将提供关于他们自己及其以自我为中心的网络成员的信息。 网络信息将与从CA-MRSA潜在储备库收集的数据进行补充 社区(例如，日托设施和学校)。这些地点的受试者将被匿名抽样检查 CA-MRSA定植/感染。结果将用于创建传播概率的估计 用于个人、网络和社区参数。然后将开发一个数学模型来模拟 社区内的传播途径，以及调查可能 用于防止CA-MRSA传播。2.金黄色葡萄球菌菌株是否在群落中进化并成为 更能适应环境吗？我们假设CA-MRSA菌株适应他们的环境和 随着它们的传播，变得更符合生态环境。在不同群体中流行的精选菌株 人口的亚群(例如，托儿所的儿童)将接受使用比较总数的遗传分析 基因组测序。可能增强健康的突变将使用生长等参数进行筛选 死亡率、对不同组织表面的粘附率以及在环境表面上的存活率。屏幕上的“健身” 然后，将对从社区收集的所有金黄色葡萄球菌菌株进行突变。 这项建议调查了CA-MRSA在市中心人群中的传播情况。我们最近完成的疾控中心 研究表明，社区有兴趣和愿意参与这些类型的调查。 与美国的其他社区不同，CA-MRSA最近才开始成为一个突出的 所以在CA-MRSA成为 地方病。最后，这项调查是对多种研究方法的创新整合，包括社会调查 网络数据收集策略、分子流行病学、遗传菌株分析和数学建模 来解决这个紧迫的问题。最终结果应该是对CA-MRSA有更全面的了解 传播和最有可能在社区环境中取得成功的干预策略。

Antibiotic-resistant S. aureus infections are now increasingly encountered in the community. These community-based infections, especially those due to methicillin-resistant S. aureus (MRSA), have occurred in groups without the usual risk factors. There is minimal understanding of how these strains spread and subsequently become established within communities. This remains a critical issue if interventions are to be designed to prevent population level dissemination of community-associated (CA)-MRSA isolates. This study will address the following questions. 1. What pressures are responsible for the pathways of CA-MRSA spread within the community? Patterns of CA-MRSA transmission within the Columbia University Medical Center catchment area, a largely underserved immigrant population, will be identified. The study will use a retrospective, case control study design. lndex cases with a documented CA-MRSA infection and community matched index controls will provide information on both themselves and their egocentric network members. Network information will be supplemented with data collected from potential reservoirs of CA-MRSA within the community (e.g., daycare facilities and schools). Subjects at these sites will be anonymously sampled for colonization/infection with CA-MRSA. The results will be used to create estimates of transmission probabilities for individual, network and community parameters. A mathematical model will then be developed to simulate transmission pathways within the community, as well as investigate potential intervention strategies that might be used to prevent CA-MRSA transmission. 2. Do strains of S. aureus evolve in the community and become more adapted to the environment? We hypothesize that CA-MRSA strains adapt to their environment and become more ecologically "fit" as they spread. Selected strains prevalent in the community among different subgroups of the population (e.g., children at daycare) will undergo genetic analysis using comparative total genome sequencing. Mutations that might enhance fitness will be screened using parameters such as growth rate, adherence to different tissue surfaces and survival on environmental surfaces. Screens for the "fitness" mutations will then be carried out on all S. aureus strains collected from the community. This proposal examines the spread of CA-MRSA in an inner city population. Our recently completed CDC study demonstrated that the community is interested and willing to participate in these types of investigations. Unlike other communities in the United States, CA-MRSA has only recently begun to emerge as a prominent pathogen in this community so that transmission studies are still possible, before CA-MRSA becomes endemic. Finally, this investigation is an innovative integration of diverse research methods including social network data collection strategies, molecular epidemiology, genetic strain analysis and mathematical modeling to address this pressing issue. The end result should be a more comprehensive understanding of CA-MRSA transmission and the intervention strategies that are most likely to be successful in a community setting.