application) This award will prepare Ebbing Lautenbach M.D., M.P.H., for a career as an independent investigator in Infectious Diseases epidemiology with a particular focus on the proper use of antimicrobial agents and the emergence of antimicrobial resistance. He proposes a comprehensive, interdisciplinary program that will provide him with the skills and experience necessary for independent patient-oriented research. The training component includes advanced education in clinical epidemiology and biostatistics, training in Hospital Epidemiology, and dual mentorship from an internationally recognized pharmacoepidemiologist and a highly experienced Infectious Diseases clinical researcher. The research component of the Award will focus on resistance to the fluoroquinolone (FQ) antibiotics among nosocomial urinary tract infections (UTIs). UTIs are by far the most common of nosocomial infections and are responsible for significant morbidity, mortality, and cost associated with hospitalization. FQ antibiotics have played an increasingly important role in the treatment of nosocomial UTIs particularly as resistance to other first line antibiotics has become widespread. The utility of FQ antibiotics in this setting is, however, seriously threatened by the emergence of resistance to these agents in recent years. Causes of FQ resistance in nosocomial UTIs are unclear and whether risk factors for FQ resistance vary across different infecting organisms has not been studied. This proposal will investigate risk factors for FQ resistance for individual pathogens as well as for gram-positive and gram-negative pathogens as distinct groups. These data will then be used to develop clinical prediction rules for FQ resistance in patients with UTI. Finally, the impact of FQ resistance will be investigated by comparing the outcomes of patients with FQ-resistant and FQ-susceptible infections. This work will provide a basis for the control of the emergence of FQ resistance. Future studies will be planned to evaluate the effect of interventions designed to decrease the emergence of resistance as well as the effect of the prediction rules in selecting more effective empiric antimicrobial therapy for patients with nosocomial UTI.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23DK002897-05
Application #
6772466
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Moen, Laura K
Project Start
2000-09-30
Project End
2006-06-30
Budget Start
2004-07-01
Budget End
2006-06-30
Support Year
5
Fiscal Year
2004
Total Cost
$135,594
Indirect Cost
Name
University of Pennsylvania
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Rattanaumpawan, P; Tolomeo, P; Bilker, W B et al. (2011) Risk factors for fluoroquinolone resistance in Enterococcus urinary tract infections in hospitalized patients. Epidemiol Infect 139:955-61
Rattanaumpawan, Pinyo; Tolomeo, Pam; Bilker, Warren B et al. (2011) A clinical prediction rule for fluoroquinolone resistance in healthcare-acquired gram-negative urinary tract infection. Infect Control Hosp Epidemiol 32:1124-6
Rattanaumpawan, P; Tolomeo, P; Bilker, W B et al. (2010) Risk factors for fluoroquinolone resistance in Gram-negative bacilli causing healthcare-acquired urinary tract infections. J Hosp Infect 76:324-7
Shiley, Kevin T; Lautenbach, Ebbing; Lee, Ingi (2010) The use of antimicrobial agents after diagnosis of viral respiratory tract infections in hospitalized adults: antibiotics or anxiolytics? Infect Control Hosp Epidemiol 31:1177-83
Lautenbach, Ebbing; Nachamkin, Irving; Hu, Baofeng et al. (2009) Surveillance cultures for detection of methicillin-resistant Staphylococcus aureus: diagnostic yield of anatomic sites and comparison of provider- and patient-collected samples. Infect Control Hosp Epidemiol 30:380-2