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

项目总结/摘要 在疗养院接受护理的个人由于以下原因而预防性地经历不良后果： 多重抗药性生物体这项调查将集中在一种常见的地方性和致命的病原体， 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-耳念珠菌，这两者都与美国的大量发病率和死亡率有关。 养老院虽然MRSA一直是医院的主要预防目标，但几乎没有采取任何措施来解决 这种病原体在疗养院，尽管事实上，疗养院有3倍高MRSA患病率 医院和疗养院的MRSA携带者每年有40%的感染风险。 由于MRSA在疗养院的风险现在由C.耳，它被称为 “真菌MRSA”由于类似的传播特征，包括显着的倾向，殖民 身体和坚持表面上的时间较长。C.耳炎与顽固性疾病爆发有关， 高归因死亡率的疗养院; 5-10%的已知携带者发展为侵入性感染，30- 60%的侵入性感染者因此死亡。因此，确定哪些养老院居民在 MRSA和C.耳道对于有效的反应和控制至关重要。 该提案的总体目标是产生关于MRSA和C.耳架和 污染的护理院，告知干预措施，以控制这些重要的病原体。第一 目的是确定与MRSA相关的疗养院设施特征和居民风险因素， C.耳车。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高接触护理活动（例如，敷料，洗澡）的MRSA 和C.耳载体在其直接环境中引起高接触物体的污染。如果是这样， 活动后清洁对减少MRSA和C.防止耳污染和减轻传播。 我（Gabrielle Gussin，MS）正在攻读博士学位。他是加州大学欧文分校公共卫生专业的教授。这 F31奖学金将使我能够将我以前的系统生物学硕士培训与以下技能联系起来： 流行病学、临床研究和人口健康。我将接受多学科团队的指导， 临床传染病、流行病学、耐多药微生物、公共卫生、护理方面的专业知识 家庭操作和生物统计学，以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.