Multiple-site decontamination in mechanically ventilated ICU patients: A real-life study - 05/05/23
, Clarisse Dupin b, Eleonore Legris c, Yannick Fedun d, Nicolas Barbarot a, François Legay a, Guilhem Wattecamps e, Florence Le Gall f, Béatrice La Combe g, Pierre Bouju g, Aurélien Frerou h, Laura Muller h, Guillaume Rieul d, Pierre Fillatre aHighlights |
• | Multiple site decontamination (MSD) decreases the risk of ICU-acquired infection. |
• | VAP and BSI incidences were lower in patients receiving MSD. |
• | There was no increase in MDRO acquisition. |
• | ICU that apply MSD had lower consumption of high resistance-promoting beta-lactam. |
Abstract |
Introduction |
Decontamination regimen decreases acquired infection (ICU-AI) incidence but has remained controversial, mostly because it contains a course of intravenous antibiotic. Multiple-site decontamination (MSD), which does not include systemic antibiotics, has been less widely studied but is associated with lower risks of ventilator-associated pneumonia (VAP), bloodstream infection (BSI) and multidrug resistant micro-organism (MDRO) acquisition. We aimed to confirm these favorable outcomes.
Methods |
A prospective pre/post-observational study was conducted in 5 ICUs in western France. Among them, 4 implemented MSD, whereas the fifth applied standard care (SC) throughout the study period. Patients who required intubation were eligible for study and divided into two groups: the MSD group if they were admitted to an ICU that already implemented MSD, or the SC group. The primary objective was to measure ICU-AI incidence.
Results |
Close to 1400 (1346) patients were available for analysis (334 in the MSD and 1012 patients in the SC group). In a multivariable Poisson regression model, MSD was independently associated with decreased incidence of ICU-AI (IRR = 0.33; 95 %CI [0.18–0.60] p < 0.001). Non-parsimonious propensity-score matching resulted in 334 patient-pairs with well-balanced baseline characteristics. There was a lower incidence of ICU-AI(6.3 % vs 20.7 % p < 0.001), VAP (3.6 % vs 16.2 % p < 0.001) and BSI (3.0 % vs 7.2 % p = 0.029) in the MSD group as compared with the SC group. Five (1.5 %) and 11 (3.3 %) patients respectively acquired MDRO (p = 0.206).
Conclusion |
MSD is associated with decreased risk of ICU-AI, VAP and BSI, with no increase in MDRO acquisition.
Le texte complet de cet article est disponible en PDF.Keywords : Critical care, Pneumonia, Bacteremia, Mortality, Acquired infection
Abbreviations : ICU-AI, MSD, VAP, BSI, MDRO, SC, ICU, CLIN, STROBE, CT, SAPS II, ESBL-PE
Plan
Vol 53 - N° 3
Article 104666- avril 2023 Retour au numéro
Article précédent
- Antibiotic therapy in the emergency room: Optimal prescription is indeed the best
- F. Moretto, F. Catherine, B. Martha, T. Sixt, P. Chavanet, M. Blot, P. Ray, L. Piroth
- Family physicians’ practices and attitudes towards HPV vaccination since extension of HPV vaccination to males
- C. Habermacher, B. Lalloué, V. Lamouille, N. Thilly, N. Agrinier
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?