Impact of decolonization on MRSA transmission in neonates

 描述(申请人提供)：金黄色葡萄球菌(金黄色葡萄球菌)是导致新生儿医疗保健相关感染(HAI)的第二大常见病原体。对常见抗生素，特别是耐甲氧西林金黄色葡萄球菌(MRSA)具有耐药性的金黄色葡萄球菌菌株，占新生儿金黄色葡萄球菌感染的35%，相关死亡率高达25%。尽管采取了积极的措施预防新生儿感染金黄色葡萄球菌，但金黄色葡萄球菌病在这一人群中的负担仍然很高。我们提出了一种新的方法来评估非殖民化在NICU预防金黄色葡萄球菌传播的有效性。我们的初步数据表明，MRSA的传播可能是由未经治疗的新生儿推动的，非殖民化可能会减少NICU中的MRSA传播。我们建议使用概率模型来评估非殖民化和殖民压力对MRSA传播的影响，同时考虑传播中的其他相关因素，如医护人员手卫生依从性和MRSA菌株类型。我们的长期目标是确定和测试将减少MRSA在新生儿中传播和感染的干预措施。具体目的是优化衡量非殖民化对新生儿重症监护室中MRSA传播的独立影响的方法，并在一项多中心回溯性队列研究中确定非殖民化对新生儿MRSA传播的影响。在SubAim 1中，我们将确定一组 住进JHH NICU的新生儿，并使用概率模型评估殖民压力和非殖民化对MRSA传播的影响。在次级目标2中，使用从两个合作的NICU获得的数据，我们将测试方法的可传导性和次级目标1中建立的结果的有效性。这项建议的结果可能会为未来的前瞻性研究或彻底改变实践提供参考。

 DESCRIPTION (provided by applicant): Staphylococcus aureus (S. aureus) is the second most common pathogen causing healthcare associated infection (HAI) in neonates. S. aureus strains with resistance to common antibiotics, specifically methicillin- resistant S. aureus (MRSA), account for up to 35% of S. aureus infections in neonates and have an associated mortality of up to 25%. Despite aggressive measures to prevent S. aureus infections in neonates, the burden of S. aureus disease remains high in this population. We propose a new approach to assess the effectiveness of decolonization for prevention of S. aureus transmission in the NICU. Our preliminary data suggest that MRSA transmission may be driven by untreated neonates and decolonization may reduce MRSA transmission in the NICU. We propose to use probabilistic models to assess the impact of decolonization and colonization pressure on MRSA transmission, while accounting for other relevant factors in transmission, such as healthcare worker hand hygiene compliance and MRSA strain type. Our long term goal is to identify and test interventions that will reduce MRSA transmission and infections in neonates. The specific aims are to optimize methods for measuring the independent effect of decolonization on MRSA transmission in the NICU, and to determine the impact of decolonization on MRSA transmission in neonates in a multicenter retrospective cohort study. In Sub aim 1, we will identify a cohort of neonates admitted to the JHH NICU and assess the impact of colonization pressure and decolonization on MRSA transmission using probabilistic models. In Sub aim 2, using data obtained from two collaborating NICUs, we will test the exportability of the methods and the validity of the findings established in Sub aim 1. The findings of this proposal could inform futur prospective studies or change practice outright.