Risk Factors for Community-Onset Healthcare-Acquired Urinary Tract Infections

描述(由申请人提供)：尿路感染(UTI)是与医疗保健相关的最大单一类型感染。由于多药耐药尿路病原体的流行程度上升，与医疗保健相关的尿路感染的过度发病率和费用现在可能正在增加。虽然对这些感染的监测和流行病学研究很广泛，但很大程度上仅限于在住院期间发现的感染。然而，感染与医疗保健相关的感染的风险并不会在出院后立即结束。因此，我们的长期目标是评估社区发病的、与医疗保健相关的尿路感染在患者群体中的负担，并利用流行病学数据开发旨在减少与医疗保健相关的尿路感染发生率的干预措施。这项申请中提出的研究的目的是收集初步数据，以指导未来社区发病的、与医疗保健相关的尿路感染的流行病学研究。为了实现我们的目标，我们提出了以下目标：(1)估计俄勒冈健康与科学大学(OHSU)家庭医学服务住院患者中被诊断为社区起病的医院获得性尿路感染的发生率，以及(2)确定社区起病、医疗保健相关尿路感染的潜在危险因素。这项研究将在OHSU家庭医学患者群体中进行，该患者群体已经制定了实践协议，以建立在住院和门诊保健接触中为患者提供连续性护理。为了实现目标1，我们将量化高危患者中社区发病的、与医疗保健相关的尿路感染的新诊断。为实现目标2，我们将采用配对病例对照设计进行初步研究。拟议的试点研究将对我们的患者群体中社区发病的、与医疗保健相关的尿路感染的发病率进行估计，并提供所需的初步数据，以设计一项更大、更有力的流行病学研究，以确定这些感染的风险因素。我们预计，这些数据将反过来促进干预措施的发展，通过识别那些社区发病的、与医疗保健相关的尿路感染风险最高的患者来减少这些感染的发生率。 公共卫生相关性：尿路感染是医疗保健相关感染的最大单一类别，但几乎没有努力量化出院后与医疗保健相关的尿路感染的发生情况。这项研究旨在提供对这些感染的流行病学的洞察，并为未来这一领域的研究提供基础。

DESCRIPTION (provided by applicant): Urinary tract infections (UTIs) represent the largest single type of healthcare-associated infections. The excess morbidity and costs attributable to healthcare-associated UTIs may now be increasing due to the rising prevalence of multi-drug resistant uropathogens. While surveillance and epidemiologic studies of these infections have been widespread, they have largely been limited to those infections that are identified during hospitalization. Yet the risk of acquiring a healthcare-associated infection does not end immediately upon discharge from the hospital. Thus, our long-term goal is to estimate the burden of community-onset, healthcare-associated UTI in our patient population and to utilize epidemiologic data to develop interventions aimed at reducing the incidence of healthcare-associated UTIs. The objective of the research proposed in this application is to collect preliminary data that can guide future epidemiologic studies of community-onset, healthcare-associated UTIs. To accomplish our objective, we propose the following aims: (1) estimate the incidence of community-onset, hospital- acquired urinary tract infections diagnosed among patients hospitalized in the family medicine service at Oregon Health & Science University (OHSU), and (2) identify potential risk factors for the development of community-onset, healthcare-associated urinary tract infections. This research will be set within the OHSU Family Medicine patient population, which has practice agreements in place to establish continuity of care for patients across inpatient and outpatient healthcare encounters. To accomplish Aim 1, we will quantify new diagnoses of community-onset, healthcare-associated UTI among at-risk patients. To accomplish Aim 2, we will conduct a pilot study using the matched case-control design. The proposed pilot study will result in an estimate of the incidence of community-onset, healthcare-associated UTIs in our patient population and provide the preliminary data needed to design a larger, well-powered epidemiologic study to identify the risk factors for these infections. We anticipate that these data will in turn facilitate the development of interventions to reduce the incidence of these infections by identifying those patients at the highest risk for community-onset, healthcare-associated UTIs. PUBLIC HEALTH RELEVANCE: Urinary tract infections represent the largest single category of healthcare-associated infections, yet there has been little effort to quantify the occurrence of healthcare- associated urinary tract infections after discharge from the hospital. This research aims to provide insight into the epidemiology of these infections and provide the foundation for future research in this area.