The INFECTADO study: INFECTions Acquired by persons on maintenance hemoDialysis during hOspitalizations

摘要 美国每年有50多万人需要维持性血液透析(PMHD)， 对黑人或西班牙裔人的影响不成比例。PMHD是医疗研究机构 和质量优先的人口。感染是pMHD死亡的第二大常见原因，原因是 尿毒症引起的免疫受损状态和多种并存。PMHD也有很大的风险 医院获得性感染(HAI)，因为他们平均每年入院两次。与.相比 普通住院人群发生HAI的风险是pMHD的2.4倍。有一个 关于pMHD中HAI流行病学的数据极其匮乏，包括潜在的种族和 种族差异。在这项题为“INFECTADO研究：人在以下方面获得的感染”的提案中 住院期间维持血液透析“，我们将量化和描述HAI的流行病学 在pMHD中。因此，这项建议将产生重要的信息，如如何最好地改善当前 旨在减少pMHD中HAI的预防策略。在目标1和目标2下，我们将使用美国肾脏 数据系统(USRDS)，一个全国性的医疗保险数据库，以分析患病率、风险因素和结果 HAI在8年的研究期内(每年约360,000 pMHD)。分析还将集中在MHD通道类型上， 健康的种族/族裔和社会决定因素。在目标3下，我们将利用疾病控制中心和 预防的国家医疗安全网络基于来自全国31家医院的主动监测数据 匹兹堡大学医学中心医院网络在8年内(每年约4777 pMHD)，到 进一步描述禽流感的流行病学特征，包括致病病原体和抗菌素耐药性概况。通过 使用两个不同的数据源，将获得pMHD中HAI流行病学的完整特征， 因为如提案所述，每个数据源都提供补充数据。跨学科团队是 由研究人员组成，他们产生了大量学术上的终末期肾病研究 过去20年的努力，并拥有pMHD感染方面的专业知识，使用USRDS进行数据分析 和HAI主动监控方法。具体目标的摘要是1]目标1和2：量化和 描述有无HAI以及两者之间的所有pMHD中HAI的患病率、危险因素和结果：a] 中心VS家庭MHD，b]黑人VS其他种族的MHD和c]西班牙裔VS非西班牙裔 MHD患者，使用USRDS数据库和2]目标3：量化和描述HAI流行病学 在患有HAI的pMHD与患有HAI的住院患者之间进行比较，包括致病原菌和 使用主动感染监测的抗菌素耐药谱。这项提议将导致增加 PMHD高危人群对HAI流行病学的了解及其健康差距 并将提供重要信息，以指导未来旨在减少人类健康指数的预防战略 以及改善患者的预后。

ABSTRACT More than 500,000 persons require maintenance hemodialysis (pMHD) per year in the United States, disproportionately affecting persons who are Black or Hispanic. pMHD are an Agency of Healthcare Research and Quality priority population. Infections are the second most common cause of mortality among pMHD due to a uremia-induced immunocompromised state and multiple co-morbidities. pMHD are also at substantial risk of hospital-acquired infections (HAI) as they are admitted to the hospital on average twice per year. Compared to the general hospitalized population, pMHD have a 2.4-fold higher risk of developing an HAI. There is a tremendous paucity of data pertaining to the epidemiology of HAI among pMHD, including potential racial and ethnic disparities. In this proposal, entitled “The INFECTADO study: INFECTions Acquired by persons on maintenance hemoDialysis during hOspitalizations”, we will quantify and characterize the epidemiology of HAI among pMHD. This proposal will therefore generate important information as how to best improve current prevention strategies aimed at reducing HAI in pMHD. Under aims 1 and 2, we will use the Unites States Renal Data System (USRDS), a nationwide-Medicare database, to analyze prevalence, risk factors and outcomes of HAI over an 8-year study period (~360,000 pMHD per year). Analyses will also focus on MHD modality type, race/ethnicity and social determinants of health. Under aim 3, we will use the Centers for Disease Control and Prevention’s National Healthcare Safety Network-based active surveillance data from 31 hospitals within the University of Pittsburgh Medical Center hospital network over an 8-year period (~4,777 pMHD per year), to further characterize HAI epidemiology, including causative pathogens and antimicrobial resistance profiles. By using two different data sources, a complete characterization of HAI epidemiology among pMHD will be obtained, since each data source provides supplementary data, as outlined in the proposal. The interdisciplinary team is comprised of investigators who have produced an abundance of scholarly end-stage renal disease research efforts over the last 2-decades and have expertise in infections among pMHD, data analyses using the USRDS and HAI active surveillance methodologies. A summary of specific aims are 1] Aims 1 and 2: To quantify and characterize HAI prevalence, risk factors and outcomes among all pMHD with and without HAI, and between: a] in-center vs home MHD, b] Black persons vs persons of other races on MHD and c] Hispanic vs non-Hispanic persons on MHD, using the USRDS database and 2] Aim 3: To quantify and characterize HAI epidemiology among pMHD with an HAI compared to hospitalized persons with an HAI, including causative pathogens and antimicrobial resistance profiles, using active infection surveillance. This proposal will result in an increased understanding of HAI epidemiology among the high-risk group of pMHD and health disparities within this population, and will provide important information to guide future prevention strategies aimed at reducing HAI and improving patient outcomes.