WASHINGTON UNIVERSITY & BJC EPICENTER FOR PREVENTION OF HEALTHCARE ASSOCIATED INFECTIONS

华盛顿大学（WU）和BJC预防中心（PE）与CDC合作， 其他PE进行研究，并将基础，流行病学和技术发现转化为新的 预防和减少医疗保健相关感染（HAI）和抗菌素耐药性（AR）的策略。 WU PE在HAI和AR预防方面的研究生产力和领导力得到国际认可。 WU拥有出色的研究基础设施，并在美国顶级医疗中心中排名。 医院综合保健服务系统，包括两个“十大”学术医院。对于我们的核心和 3个多中心合作提案，我们组织了一支由基础、翻译和临床研究人员组成的团队， 传染病、卫生保健流行病学、微生物学、AR、微生物组和代谢组方面的专业知识 科学家们共同努力进行转化研究，以预防HAI和AR。我们建议广泛的四年 我们核心提案中的研究战略侧重于开发和测试新的战略，以：记录和 改善门诊抗生素处方实践，减少手术部位感染（SSI）， 粪便微生物组移植（FMT）后的AR和肠道微生物组，并确定新的生物标志物， 快速诊断尿路感染，避免对无症状菌尿使用不必要的抗生素。 为了实现我们核心提案中的这些目标，我们提出以下具体目标： 1.确定抗生素处方的做法之间的牙医在美国利用快递公司，一个大型 药房福利管理员数据库; 2.通过增强的恢复捆绑包减少结直肠手术后的SSI，并实施和 扩大全面护理计划; 3.使用临床数据增强个体女性现有乳房切除术SSI风险预测模型 电子健康记录（EHR）中的信息，并集成增强的风险预测模型 纳入EHR，供外科医生用于传达个体化SSI风险并优化SSI 对接受乳房切除术的妇女采取预防措施; 4.确定粪便微生物组移植（FMT）对复发性结肠癌患者的影响 艰难梭菌感染（CDI）对肠道多药耐药微生物（MDRO）定植的影响 为双盲、剂量反应、随机对照试验采集的标本; 5.确定住院患者高危菌尿的代谢组学生物标志物。 我们还提交了3份提案，以领导与 杜克大学、宾夕法尼亚大学和Hektoen/Rush PE作为我们多中心提案的参与者。

The Washington University (WU) and BJC Prevention Epicenter (PE) works collaboratively with CDC and other PEs to perform research and to translate basic, epidemiology and technologic discoveries into new strategies to prevent and decrease healthcare associated infections (HAIs) and antimicrobial resistance (AR). The WU PE is internationally recognized for research productivity and leadership in HAI and AR prevention. WU has outstanding research infrastructure and ranks in the top medical centers in the U.S. BJC is a 13- hospital integrated healthcare delivery system including two “top 10” academic hospitals. For our core and 3 multicenter collaborative proposals, we organized a team of basic, translational and clinical investigators with expertise in infectious disease, healthcare epidemiology, microbiology, AR, microbiome, and metabolome sciences to work together performing translational studies to prevent HAIs and AR. We propose a broad 4 year research strategy in our core proposal focused on developing and testing novel strategies to: document and improve outpatient antibiotic prescribing practices, reduce surgical site infections (SSIs), identify changes in AR and gut microbiome following fecal microbiome transplant (FMT), and identify novel biomarkers to more rapidly diagnose urinary tract infections and avoid unnecessary antibiotics in asymptomatic bacteriuria. To achieve these goals in our core proposal, we propose the following Specific Aims: 1. Determine antibiotic prescribing practices among dentists in the US utilizing Express Scripts Inc, a large pharmacy benefits manager database; 2. Reduce SSI after colorectal surgery with an enhanced recovery bundle, and implementation and expansion of a comprehensive care package; 3. Enhance an existing mastectomy SSI risk prediction model for individual women using clinical information from the electronic health record (EHR) and integrate the enhanced risk prediction model into the EHR for use by surgeons to communicate individualized SSI risk and to optimize SSI preventive practices for women undergoing mastectomy; 4. Determine the impact of fecal microbiome transplant (FMT) administered to patients with recurrent Clostridium difficile infection (CDI) on intestinal multidrug resistant organism (MDRO) colonization from specimens collected for a double blinded, dose response, randomized controlled trial; 5. Identify metabolomic biomarkers of high-risk bacteriuria in hospitalized patients. We are also submitting 3 proposals to lead small, medium and large collaborative projects with the Duke, Univ. of Pennsylvania and Hektoen/Rush PEs as participants in our multicenter proposals.