Multiple-site decontamination regimen decreases acquired infection incidence in mechanically ventilated COVID-19 patients.
Bacteremia
COVID-19
Chlorhexidine
Critical care
Mortality
Mupirocin
Pneumonia
Selective digestive decontamination
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
02 Sep 2022
02 Sep 2022
Historique:
received:
07
04
2022
accepted:
24
08
2022
entrez:
2
9
2022
pubmed:
3
9
2022
medline:
3
9
2022
Statut:
epublish
Résumé
Among strategies that aimed to prevent acquired infections (AIs), selective decontamination regimens have been poorly studied in the COVID-19 setting. We assessed the impact of a multiple-site decontamination (MSD) regimen on the incidence of bloodstream infections (BSI) and ventilator-associated pneumonia (VAP) in COVID-19 patients receiving mechanical ventilation. We performed an ancillary analysis of a multicenter retrospective observational study in 15 ICUs in western France. In addition to standard-care (SC), 3 ICUs used MSD, a variant of selective digestive decontamination, which consists of the administration of topical antibiotics four times daily in the oropharynx and the gastric tube, chlorhexidine body wash and a 5-day nasal mupirocin course. AIs were compared between the 3 ICUs using MSD (MSD group) and the 12 ICUs using SC. During study period, 614 of 1158 COVID-19 patients admitted in our ICU were intubated for at least 48 h. Due to missing data in 153 patients, 461 patients were finally included of whom 89 received MSD. There were 34 AIs in the MSD group (2117 patient-days), as compared with 274 AIs in the SC group (8957 patient-days) (p < 0.001). MSD was independently associated with a lower risk of AI (IRR = 0.56 [0.38-0.83]; p = 0.004) (Table 2). When the same model was used for each site of infection, MSD remained independently associated with a lower risk of VAP (IRR = 0.52 [0.33-0.89]; p = 0.005) but not of BSI (IRR = 0.58, [0.25-1.34], p = 0.21). Hospital mortality was lower in the MSD group (16.9% vs 30.1%, p = 0.017). In ventilated COVID-19 patients, MSD was independently associated with lower AI incidence.
Sections du résumé
BACKGROUND
BACKGROUND
Among strategies that aimed to prevent acquired infections (AIs), selective decontamination regimens have been poorly studied in the COVID-19 setting. We assessed the impact of a multiple-site decontamination (MSD) regimen on the incidence of bloodstream infections (BSI) and ventilator-associated pneumonia (VAP) in COVID-19 patients receiving mechanical ventilation.
METHODS
METHODS
We performed an ancillary analysis of a multicenter retrospective observational study in 15 ICUs in western France. In addition to standard-care (SC), 3 ICUs used MSD, a variant of selective digestive decontamination, which consists of the administration of topical antibiotics four times daily in the oropharynx and the gastric tube, chlorhexidine body wash and a 5-day nasal mupirocin course. AIs were compared between the 3 ICUs using MSD (MSD group) and the 12 ICUs using SC.
RESULTS
RESULTS
During study period, 614 of 1158 COVID-19 patients admitted in our ICU were intubated for at least 48 h. Due to missing data in 153 patients, 461 patients were finally included of whom 89 received MSD. There were 34 AIs in the MSD group (2117 patient-days), as compared with 274 AIs in the SC group (8957 patient-days) (p < 0.001). MSD was independently associated with a lower risk of AI (IRR = 0.56 [0.38-0.83]; p = 0.004) (Table 2). When the same model was used for each site of infection, MSD remained independently associated with a lower risk of VAP (IRR = 0.52 [0.33-0.89]; p = 0.005) but not of BSI (IRR = 0.58, [0.25-1.34], p = 0.21). Hospital mortality was lower in the MSD group (16.9% vs 30.1%, p = 0.017).
CONCLUSIONS
CONCLUSIONS
In ventilated COVID-19 patients, MSD was independently associated with lower AI incidence.
Identifiants
pubmed: 36053369
doi: 10.1186/s13613-022-01057-x
pii: 10.1186/s13613-022-01057-x
pmc: PMC9438389
doi:
Types de publication
Journal Article
Langues
eng
Pagination
84Informations de copyright
© 2022. The Author(s).
Références
Lancet Infect Dis. 2013 Aug;13(8):665-71
pubmed: 23622939
Ann Intensive Care. 2020 Sep 7;10(1):119
pubmed: 32894364
Lancet. 2021 May 01;397(10285):1637-1645
pubmed: 33933206
Ann Intensive Care. 2021 Dec 24;11(1):183
pubmed: 34952960
Clin Microbiol Infect. 2012 Mar;18(3):268-81
pubmed: 21793988
Crit Care. 2020 Jun 5;24(1):289
pubmed: 32503590
Intensive Care Med. 2021 Jan;47(1):60-73
pubmed: 33211135
Infect Dis (Lond). 2021 Feb;53(2):154-157
pubmed: 33103562
N Engl J Med. 2009 Jan 1;360(1):20-31
pubmed: 19118302
Intensive Care Med. 2021 Feb;47(2):188-198
pubmed: 33388794
Crit Care. 2021 Dec 20;25(1):445
pubmed: 34930419
Am J Respir Crit Care Med. 2021 Sep 1;204(5):546-556
pubmed: 34038699
Anaesth Crit Care Pain Med. 2022 Feb;41(1):100987
pubmed: 34844031
Lancet Respir Med. 2015 Nov;3(11):859-68
pubmed: 26472037
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
Crit Care Med. 2014 May;42(5):1121-30
pubmed: 24365857
Clin Infect Dis. 2016 Sep 1;63(5):e61-e111
pubmed: 27418577
Microorganisms. 2021 Sep 23;9(10):
pubmed: 34683337
Crit Care. 2021 May 25;25(1):177
pubmed: 34034777
Crit Care Med. 2005 Feb;33(2):307-14
pubmed: 15699832
Cochrane Database Syst Rev. 2009 Oct 07;(4):CD000022
pubmed: 19821262
Ann Intensive Care. 2021 Oct 2;11(1):143
pubmed: 34601646
Sci Immunol. 2020 Jul 15;5(49):
pubmed: 32669287
JAMA. 2018 Nov 27;320(20):2087-2098
pubmed: 30347072
Intensive Care Med. 2012 Dec;38(12):1930-45
pubmed: 23011531
Lancet. 2003 Sep 27;362(9389):1011-6
pubmed: 14522530
Eur J Clin Microbiol Infect Dis. 2020 May;39(5):889-895
pubmed: 31898797