CK20-004, Duke-UNC Prevention Epicenter Program for Protecting Patients from Infections, Antibiotics Resistance and Other Adverse Events

Project Summary
Healthcare-associated infections (HAIs) and antimicrobial resistance (AR) lead to adverse patient outcomes,
including increased mortality, morbidity, and length of hospitalization. While progress in prevention is occurring,
innovative and improved strategies for prevention of HAIs, AR, and patient harm are needed. The overall
objective of this proposal is to identify potential strategies to decrease HAIs and prevent AR emergence,
transmission, and acquisition. Our Core Proposal includes 6 unique studies to address 4 specific lines of
investigation (specific aims [SA]): environmental disinfection, antimicrobial stewardship, diagnostic stewardship,
and community-acquired Clostridioides difficile infection (CA-CDI). These studies will 1) evaluate novel
strategies to decrease environmental contamination with opportunistic premise plumbing pathogens related to
hospital sinks using a) Pall filters and drain covers (SA1A) and b) engineered plasmids (SA1B); 2) identify and
evaluate innovative antimicrobial stewardship (AS) interventions and metrics to decrease AR and patient harm
a) at transitions of care (e.g., discharge) in community hospitals (SA2A) and b) related to post-operative
antibiotics (SA2B); 3) develop and validate reflex urine culture criteria to guide improved utilization of urine
cultures (SA3); and 4) evaluate and determine the contribution of environmental sources on acquisition and
occurrence of CA-CDI (SA4). These studies involve patients admitted to community and academic hospitals as
well as patients in the community setting. We will achieve this objective by using the strengths of a unique,
innovative, and previously successful collaboration between investigators in the Duke Center for Antimicrobial
Stewardship and Infection Prevention and the University of North Carolina at Chapel Hill. We will capitalize on
programmatic strengths in both institutions: expertise in environmental disinfection, antimicrobial stewardship,
infection prevention, AR, epidemiology, surveillance, and emerging infections; access to large and unique
research networks and infrastructure; and proven success with collaborative research involving multiple
institutions. All Core Projects proposed in this application represent early stage translational research (T0-T1)
with clearly identified “next steps” that will help expedite identification and development of practices that
effectively prevent HAIs and AR. In addition, we are proposing 3 Collaborative Projects with other CDC
Prevention Epicenters Programs: 1) a cluster randomized non-inferiority crossover trial on the use of contact
precautions for MRSA and VRE acquisition (Large); 2) evaluation of the feasibility and utility of robust antibiotic
use risk-adjustment machine learning models (Medium); and 3) metagenomic evaluation to determine if and how
often endogenous flora contaminate surgical wounds (Small). These studies involve patients admitted to
community and academic hospitals. Overall, these studies exemplify our ongoing collaboration between
scientists with expertise in T0 metagenomics, bioengineering, and microbiology and researchers with expertise
in T1-T2 studies. The contribution of these studies will be significant because they will lead to new strategies to
prevent HAIs, AR, and patient harm, thereby improving the health and safety of the US population.

Grant Number: 5U54CK000616-05
NIH Institute/Center: ALLCDC
Principal Investigator: Deverick Anderson