Decline of multidrug-resistant Gram negative infections with the routine use of a multiple decontamination regimen in ICU

Christophe Camus (1, 2) , Elise Sauvadet (1, 2) , Aude Tavenard (1, 3) , Caroline Piau (2) , Fabrice Uhel (4, 1, 5) , Pierre Bouju (5, 4) , Julien Letheulle (5, 4) , Gilles Dollo (6, 2) , Arnaud Gacouin (1, 5) , Sylvain Lavoué (5, 2) , Yves Le Tulzo (1, 5, 4)

1 CIC - Centre d'Investigation Clinique [Rennes]
2 CHU Pontchaillou [Rennes]
3 Service de Pharmacologie [Rennes]
4 Biosit : Biologie - Santé - Innovation Technologique - Structure Fédérative de Recherche en Biologie et Santé de Rennes
5 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
6 Laboratoire de Pharmacie Galenique, Biopharmacie et Pharmacie Clinique [Rennes]

Objectives: We have shown that the routine use of a multiple decontamination regimen with oropharyngeal and digestive polymyxin/tobramycin/amphotericin B plus mupirocin/chlorhexidine in intubated patients reduced all-cause acquired infections (AIs) in the intensive care unit (ICU). We now assessed the long-term impact of this strategy on AIs involving multidrug-resistant aerobic Gram negative bacilli (AGNB) and acquired episodes of extended-spectrum betalactamase (ESBL)-producing Enterobacteriaceae rectal carriage. Methods: This was an observational single center study of all patients admitted to an ICU over 5 years (study population). Decontamination was given for the period of intubation and standard care otherwise. AIs and colonization rates were prospectively recorded. AIs rates were compared between the study period and a 1-year pre-intervention period. During study, trends were analyzed by semester using a Poisson regression model. Results: The incidence rate of multidrug-resistant AGNB AIs was lower during the study (1.59 per 1000 patient-days, versus pre-intervention: 5.43 parts per thousand, p < 0.001) and declined with time (adjusted OR = 0.85, 95 percent confidence interval 0.77-0.93, p < 0.001). ESBL-producing Enterobacteriaceae acquired colonization episodes (OR = 0.94 [0.88-1.00] P = 0.04) and the use of five major antibiotics (p < 0.001) also declined. Conclusion: A multiple decontamination regimen did not favor the emergence of multidrug-resistant AGNB. In contrast, infection and colonization rates declined with time. (C) 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Keywords: intensive-care units; randomized clinical-trial; selective decontamination; digestive-tract; staphylococcus-aureus; acquired infections; antimicrobial resistance; antibiotic-resistance; nosocomial infection; colistin resistance

Domains: Life Sciences [q-bio]; Life Sciences [q-bio]; Pharmaceutical sciences; Life Sciences [q-bio]; Human health and pathology; Life Sciences [q-bio]; Human health and pathology; Infectious diseases

Christophe Camus, Elise Sauvadet, Aude Tavenard, Caroline Piau, Fabrice Uhel, et al.. Decline of multidrug-resistant Gram negative infections with the routine use of a multiple decontamination regimen in ICU. Journal of Infection, 2016, 73 (3), pp.200--209. ⟨10.1016/j.jinf.2016.06.007⟩. ⟨hal-01395130⟩