Southeastern Pennsylvania Adult and Pediatric Prevention Epicenter Network

描述(申请人提供)：医疗保健相关感染(HAI)，特别是那些由抗菌素耐药病原体引起的感染非常常见，并与发病率、死亡率和成本的显著增加有关。近年来，由于过度使用抗菌药，抗菌素耐药性显著增加。然而，限制不必要的抗生素使用的努力收效甚微。抗生素的不适当使用在很大程度上是由于无法识别哪些情况下不需要经验性抗生素。生物标记物在决定停止抗生素治疗方面的作用尚不清楚，特别是在危重成年人中。在儿童身上进行的研究甚至更少。生物标记物干预措施的经济影响尚不清楚。该项目的目标是减少重症监护病房(ICU)环境中不必要的抗生素使用。研究的第一阶段将确定最能识别细菌感染可能性非常低的危重患者的生物标记物(S)。在第二阶段，将测试基于生物标记物的算法对减少抗生素使用的影响。最后，我们将扩大特拉华谷病例控制网络(DVCCN)的范围，以应对未来疾控中心预防中心的倡议。具体的研究阶段和目标是：第一阶段：候选生物标记物的测试特征目标1：评估用于识别危重成人中细菌感染可能性极低的患者的候选生物标记物的测试特征目标2：评估用于识别危重儿童中细菌感染可能性极低的患者的候选生物标记物的测试特征目标1和2的假设是可以识别对细菌感染具有很高阴性预测价值的生物标志物或生物标记物的组合第二阶段：基于生物标记物的算法对抗生素使用的影响目标3：评估基于生物标记物的算法的影响关于减少危重成人抗生素的使用目标4：评估基于生物标记物的算法在减少危重儿童抗生素使用方面的影响目标3和4的假设是，基于生物标记物的算法的使用将与抗生素使用的显著减少相关次要目标1：确定生物标记物算法在成人中的增量成本(节省)次要目标2：确定生物标记物算法在儿童中的增量成本(节省)目标5：为未来的疾控中心预防中心举措扩大DVCCN的范围这项工作将为基于生物标记物的算法在减少危重患者不必要的抗生素使用方面的潜在影响提供重要的见解。建立良好的DVCCN协作将提供一个特殊的临床站点网络，在其中开展未来的CDC预防中心倡议

DESCRIPTION (provided by applicant): Healthcare-associated infections (HAIs), particularly those due to antimicrobial-resistant pathogens, are very common and are associated with significant increases in morbidity, mortality, and cost. Antimicrobial resistance has increased markedly in recent years due to overuse of antimicrobials. However, efforts to limit unnecessary antibiotic use have met with little success. Inappropriate antibiotic use is largely driven by the inability to identify conditions for which empiric antibiotics are unnecessary. The role of biomarkers in informing decisions to stop antibiotic therapy remains unclear, especially in critically ill adults. Even fewer studies have been conducted in children. The economic impact of biomarker interventions is unknown. The goal of this project is to reduce unnecessary antibiotic use in the intensive care unit (ICU) setting. Phase I of the study will identify the biomarker(s) that best identify critically ill patients who have a very low likelihood of bacterial infection. In Phase II, the impact of a biomarker-based algorithm on reducing antibiotic use will be tested. Finally, we will expand the scope of the Delaware Valley Case Control Network (DVCCN) to address future CDC Prevention Epicenter initiatives. The specific study phases and aims are: Phase I: Test Characteristics of Candidate Biomarkers Aim 1: to assess the test characteristics of candidate biomarkers for identifying patients with very low likelihood of bacterial infection among critically ill adults Aim 2: to assess the test characteristics of candidate biomarkers for identifying patients with very low likelihood of bacterial infection among critically ill children The hypotheses for Aims 1 and 2 are that a biomarker or combination of biomarkers can be identified that demonstrates a high negative predictive value for bacterial infection Phase II: Impact of a Biomarker-Based Algorithm on Antibiotic Use Aim 3: to evaluate the impact of a biomarker-based algorithm on reducing antibiotic use in critically ill adults Aim 4: to evaluate the impact of a biomarker-based algorithm on reducing antibiotic use in critically ill children The hypotheses for Aims 3 and 4 are that use of the biomarker-based algorithm will be associated with significant reductions in antibiotic use Secondary Aim 1: to determine incremental costs (savings) of the biomarker algorithm in adults Secondary Aim 2: to determine incremental costs (savings) of the biomarker algorithm in children Aim 5: to expand the scope of the DVCCN for future CDC Prevention Epicenter initiatives This work will provide crucial insights into the potential impact of biomarker-based algorithms on reducing unnecessary antibiotic use in critically ill patients. The well-established DVCCN collaborative will provide an exceptional network of clinical sites within which to conduct future CDC Prevention Epicenter initiatives