Comparative Effectiveness of Strategies to Control S. aureus Infections

描述(由申请人提供)： 金黄色葡萄球菌感染与包括退伍军人管理局医疗系统在内的世界各地医院的相当大的发病率和死亡率有关。Schweizer博士的长期职业目标是开发和评估基于证据的策略，以减少退伍军人管理局医疗保健系统中与医疗保健相关的感染的患病率和不良结局。这项申请的目的是为Schweizer博士提供在比较有效性研究、国家退伍军人管理局数据库的使用、传染病的数学建模和实施科学方面的具体培训机会，以帮助她发展为一名独立的退伍军人管理局卫生服务研究员，专门从事医院相关感染预防。该应用程序的目的是比较预防和治疗金黄色葡萄球菌感染的策略的有效性。对于金黄色葡萄球菌的预防和治疗，已经提出了多种组织级别和患者级别的策略。不幸的是，所有这些策略都有优缺点，几乎没有证据支持这些策略的有效性。目前预防金黄色葡萄球菌传播的文献评估策略往往缺乏外部有效性，因此很难将研究结果应用于不同的患者群体。2007年，退伍军人卫生管理局(VHA)耐甲氧西林金黄色葡萄球菌(MRSA)预防倡议要求所有退伍军人医学中心对所有住院患者进行鼻部MRSA检测，并限制与MRSA阳性患者的接触，以防止MRSA传播。然而，很少有研究将这一策略与其他潜在策略进行比较，以确定这是否是最 减少传播的有效和具有成本效益的战略。耐甲氧西林金黄色葡萄球菌是一种抗生素耐药形式 金黄色葡萄球菌约占所有金黄色葡萄球菌感染的一半。因此，同时预防MRSA和甲氧西林敏感金黄色葡萄球菌(MSSA)的策略可能比只关注MRSA的策略更有效。此外，对于金黄色葡萄球菌感染的最佳治疗方法，几乎没有达成共识。许多医生给所有的S开抗生素万古霉素。 金黄色葡萄球菌感染，尽管这可能不是最理想的。这项研究计划的三个目标是：1)完成对实施的不同组织级别金黄色葡萄球菌感染预防策略的有效性和成本的系统回顾和荟萃分析：a)在所有住院患者中；b)在通过医疗系统过渡的患者中；2)比较万古霉素与其他抗葡萄球菌抗生素治疗侵袭性金黄色葡萄球菌(MRSA和MSSA)感染的有效性；3)使用AIMS 1和2中收集的组织级别和患者级别的数据，创建一个决策模型，以比较预防和治疗金黄色葡萄球菌感染策略的有效性、成本和成本效益。VHA通过VHA MRSA预防倡议投入了大量时间和资源来预防MRSA的传播和感染。这项研究与VHA的使命一致，即试图确定VHA MRSA预防计划可以实施的最有效和最具成本效益的战略，以预防和治疗金黄色葡萄球菌(包括MRSA)感染。从而在我国退伍军人中预防金黄色葡萄球菌相关的发病率和死亡率。这项研究将利用荟萃分析、大型退伍军人事务部回溯性队列研究和数学模型来评估减少金黄色葡萄球菌传播、感染和死亡率的最有效和最具成本效益的策略。这些数据对于预防和治疗金黄色葡萄球菌侵袭性感染是不可或缺的。

DESCRIPTION (provided by applicant): Staphylococcus aureus infections are associated with considerable morbidity and mortality in hospitals worldwide including the VA Healthcare System. Dr. Schweizer's long term career goal is to develop and evaluate evidence based strategies to reduce the prevalence of and poor outcomes associated with healthcare-associated infections in the VA Healthcare System. The purpose of this application is to provide Dr. Schweizer with opportunities for specific training in comparative effectiveness research, use of national VA databases, mathematical modeling of infectious diseases, and implementation science to assist in her development as an independent VA health services researcher specializing in hospital-associated infection prevention. The objective of this application is to compare the effectiveness of strategies to prevent and treat S. aureus infections. Multiple organization-level and patient-level strategies have been proposed for S. aureus prevention and treatment. Unfortunately, all have advantages and disadvantages, and there is little evidence to support the effectiveness of these strategies. The current literature assessing strategies to prevent S. aureus transmission often lack external validity, thus it is difficult to apply study results to different patient populations. In 2007, th Veterans Health Administration (VHA) Methicillin-resistant S. aureus (MRSA) Prevention Initiative mandated that all VA Medical Centers test the noses of all admitted patients for MRSA and limit contact with MRSA positive patients in order to prevent MRSA spread. However, few studies have compared this strategy to other potential strategies to determine if this is the most effective and cost-effective strategy to reduce transmission. MRSA is an antibiotic resistant form of S. aureus and comprises approximately half of all S. aureus infections. Thus, strategies that aim to prevent both MRSA and methicillin-susceptible S. aureus (MSSA) may be more effective than strategies solely focused on MRSA. Additionally, there is little consensus on the optimal treatment for S. aureus infections. Many physicians prescribe the antibiotic vancomycin for all S. aureus infections although this may not be optimal. The three aims of this research proposal are: 1) Complete a systematic review and meta-analysis of the effectiveness and costs of different organization-level S. aureus infection prevention strategies implemented: a) Among all admitted patients; b) Among patients who are transitioning through the healthcare system; 2) Compare the effectiveness of vancomycin to that of other anti-staphylococcal antibiotics for the treatment of invasive S. aureus (MRSA and MSSA) infections; and 3) Using organization-level and patient-level data collected in Aims 1 and 2, create a decision model to compare the effectiveness, costs, and cost-effectiveness of strategies to prevent and treat S. aureus infections. The VHA has invested considerable time and resources into the prevention of MRSA transmission and infection through the VHA MRSA Prevention Initiative. This study is consistent with the mission of the VHA in attempting to determine the most effective and cost-effective strategies that can be implemented by the VHA MRSA Prevention Initiative to prevent and treat S. aureus (including MRSA) infections. Thus preventing S. aureus related morbidity and mortality among our nation's veterans. This study will utilize a meta-analysis, a large VA retrospective cohort study, and mathematical models to assess the most effective and cost- effective strategies to reduce transmission, infection, and mortality related to S. aureus. These data are integral to the prevention and treatment of S. aureus invasive infections.