Epidemiology of resistant bacteria in acute-care and long-term care facilities

描述（由申请方提供）：抗生素耐药性是一个日益严重的公共卫生问题，与相当大的发病率、死亡率和成本相关。鉴于抗生素发现的速度降低以及人口向日益老龄化的人口转变，医院和长期护理机构（LTCF）中老年人群的抗生素耐药性代表着即将到来的公共卫生灾难。我的长期职业目标是帮助降低医院和LTCF中耐药性感染的发生率。此应用程序的目的是为我提供机会，在老年医学，数学建模和传染病的具体培训，以协助我发展成为一个传染病流行病学家与老年医学的专业知识。本研究计划旨在提供这些机会，并将使用多学科方法评估与医院和LTCF中耐甲氧西林金黄色葡萄球菌（MRSA）定植相关的三个假设。耐甲氧西林金黄色葡萄球菌（MRSA）是最常见的耐药菌之一，也是一种常见的医院感染病原体。为了优化现有的感染控制工作，并确定控制这些病原体的其他机会，有必要适当了解和量化抗生素使用、患者移动和MRSA患者定植之间的关联。因此，我的长期目标和这个项目的目标与NLAID的使命是一致的，即试图了解并最终预防威胁数百万人生命的传染病。拟议的研究将在两年内在四个LTCF进行入院和半年一次的时点患病率研究，LTCF居民的前瞻性队列评估入院急性护理医院时MRSA的患病率和与MRSA定植相关的结局，和数学模型，以评估机构间患者移动对MRSA患病率的相对贡献以及有效性和成本-针对最近转移患者的感染控制干预措施在减少MRSA传播方面的有效性。这些数据对于预防MRSA和潜在的其他耐药性细菌感染是不可或缺的。

DESCRIPTION (provided by applicant): Antibiotic resistance is an increasing public health problem that is associated with considerable morbidity, mortality and costs. Given the reduced pace of antibiotic discovery and the approaching demographic shift towards an increasingly aged population, antibiotic resistance among the geriatric population in both hospitals and long-term care facilities (LTCFs) represents an impending public health disaster. My long-term career goal is to help reduce the incidence of antibiotic-resistant infections in both hospitals and LTCFs. The purpose of this application is to provide me with opportunities for specific training in geriatric medicine, mathematical modeling, and infectious diseases to assist in my development into an infectious disease epidemiologist with expertise in geriatric medicine. This research plan is designed to provide these opportunities and will use a multi-disciplinary approach to assess three hypotheses related to colonization by methicillin-resistant Staphylococcus aureus (MRSA) in hospitals and LTCFs. MRSA is one of the most common antibiotic-resistant bacteria and a prevalent nosocomial pathogen. Appropriate understanding and quantification of the association between antibiotic use, patient movement, and colonization of patients with MRSA are necessary in order to optimize existing infection control efforts and to identify additional opportunities for control of these pathogens. Thus, my long- term goal and the goals of this project are consistent with the mission of NlAID in attempting to understand and ultimately prevent infectious diseases that threaten millions of human lives. The proposed study will utilize admission and biannual point prevalence studies at four LTCFs over two years, a prospective cohort of LTCF residents to assess both the prevalence of MRSA upon admission to acute care hospitals and outcomes associated with colonization by MRSA, and mathematical models to assess relative contributions of inter-facility patient movement on MRSA prevalence as well as the effectiveness and cost-effectiveness of infection control interventions targeting recently transferred patients in reducing the transmission of MRSA. These data are integral to the prevention of infections by MRSA and potentially other antibiotic-resistant bacteria.