Prevention of ICU-acquired infection with decontamination regimen in immunocompromised patients: a pre/post observational study.
Acquired infection
Bacteremia
Critical care
Immunodepression
Mortality
Pneumonia
Selective decontamination of the digestive tract
Journal
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
ISSN: 1435-4373
Titre abrégé: Eur J Clin Microbiol Infect Dis
Pays: Germany
ID NLM: 8804297
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
22
05
2023
accepted:
07
08
2023
medline:
21
9
2023
pubmed:
19
8
2023
entrez:
19
8
2023
Statut:
ppublish
Résumé
Although the proportion of immunocompromised patients admitted to the ICU is increasing, data regarding specific management, including acquired infection (ICU-AI) prophylaxis, in this setting are lacking. We aim to investigate the effect of multiple-site decontamination regimens (MSD) in immunocompromised patients. We conducted a prospective pre-/post-observational study in 2 ICUs in Bretagne, western France. Adults who required mechanical ventilation for 24 h or more were eligible. During the study period, MSD was implemented in participating ICUs in addition to standard care. It consists of the administration of topical antibiotics (gentamicin, colistin sulfate, and amphotericin B), four times daily in the oropharynx and the gastric tube, 4% chlorhexidine bodywash once daily, and a 5-day nasal mupirocin course. Overall, 295 immunocompromised patients were available for analysis (151 in the post-implementation group vs 143 in the pre-implementation group). Solid organ cancer was present in 77/295 patients while immunomodulatory treatments were noticed in 135/295. They were 35 ICU-AI in 29/143 patients in the standard-care group as compared with 10 ICU-AI in 9/151 patients in the post-implementation group (p < 0.001). In a multivariable Poisson regression model, MSD was independently associated with a decreased incidence of ICU-AI (incidence rate ratio = 0.39; 95%CI [0.20-0.87] p = 0.008). There were 35/143 deaths in the standard-care group as compared with 22/151 in the post-implementation group (p = 0.046), this difference remained in a multivariable Cox model (HR = 0.58; 95CI [0.34-0.95] p = 0.048). In conclusion, MSD appeared to be associated with improved outcomes in critically ill immunocompromised patients.
Identifiants
pubmed: 37597052
doi: 10.1007/s10096-023-04650-5
pii: 10.1007/s10096-023-04650-5
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1163-1172Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
van Vliet M, Verburg IWM, van den Boogaard M et al (2014) Trends in admission prevalence, illness severity and survival of haematological patients treated in Dutch intensive care units. Intensive Care Med 40:1275–1284. https://doi.org/10.1007/s00134-014-3373-x
doi: 10.1007/s00134-014-3373-x
pubmed: 24972886
Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30. https://doi.org/10.3322/caac.21442
doi: 10.3322/caac.21442
pubmed: 29313949
Mokart D, Pastores SM, Darmon M (2014) Has survival increased in cancer patients admitted to the ICU? Yes. Intensive Care Med 40:1570–1572. https://doi.org/10.1007/s00134-014-3433-2
doi: 10.1007/s00134-014-3433-2
pubmed: 25160033
Moreau AS, Martin-Loeches I, Povoa P, Salluh J, Rodriguez A, Thille AW, Diaz Santos E, Vedes E, Lobo SM, Mégarbane B, MoleroSilvero E, Coelho L, Argaud L, Sanchez Iniesta R, Labreuche J, Rouzé A, Nseir S, TAVeM Study Group (2018) Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections. Eur Respir J 51(3):1701656. https://doi.org/10.1183/13993003.01656-2017
doi: 10.1183/13993003.01656-2017
pubmed: 29439020
Massart N, Reizine F, Fillatre P, Seguin P, La Combe B, Frerou A, Egreteau PY, Hourmant B, Kergoat P, Lorber J, Souchard J, Canet E, Rieul G, Fedun Y, Delbove A, Camus C (2022) Multiple-site decontamination regimen decreases acquired infection incidence in mechanically ventilated COVID-19 patients. Ann Intensive Care 12(1):84. https://doi.org/10.1186/s13613-022-01057-x
doi: 10.1186/s13613-022-01057-x
pubmed: 36053369
pmcid: 9438389
Camus C, Bellissant E, Sebille V et al (2005) Prevention of acquired infections in intubated patients with the combination of two decontamination regimens. Crit Care Med 33(2):307–314. https://doi.org/10.1097/01.ccm.0000152224.01949.01
doi: 10.1097/01.ccm.0000152224.01949.01
pubmed: 15699832
de Jong PJ, de Jong MD, Kuijper EJ, van der Lelie H (1993) The value of surveillance cultures in neutropenic patients receiving selective intestinal decontamination. Scand J Infect Dis 25(1):107–113
doi: 10.1080/00365549309169678
pubmed: 8460334
E.O.R.T.C. (1982) Gnotobiotic Project Group: a prospective cooperative study of antimicrobial decontamination in granulocytopenic patients. Comparison of two different methods. Infection 10(3):131–8. https://doi.org/10.1007/BF01640762
doi: 10.1007/BF01640762
Bow EJ, Rayner E, Scott BA, Louie TJ (1987) Selective gut decontamination with nalidixic acid or trimethoprim-sulfamethoxazole for infection prophylaxis in neutropenic cancer patients: relationship of efficacy to antimicrobial spectrum and timing of administration. Antimicrob Agents Chemother 31(4):551–557. https://doi.org/10.1128/AAC.31.4.551
doi: 10.1128/AAC.31.4.551
pubmed: 3300532
pmcid: 174776
Schauwvlieghe AFAD, Rijnders BJA, Philips N, Verwijs R, Vanderbeke L, Van Tienen C, Lagrou K, Verweij PE, Van de Veerdonk FL, Gommers D, Spronk P, Bergmans DCJJ, Hoedemaekers A, Andrinopoulou ER, van den Berg CHSB, Juffermans NP, Hodiamont CJ, Vonk AG, Depuydt P, Boelens J, Wauters J, Dutch-Belgian Mycosis study group (2018) Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med 6(10):782–792. https://doi.org/10.1016/S2213-2600(18)30274-1
doi: 10.1016/S2213-2600(18)30274-1
pubmed: 30076119
Massart N, Dupin C, Legris E, Fedun Y, Barbarot N, Legay F, Wattecamps G, Le Gall F, La Combe B, Bouju P, Frerou A, Muller L, Rieul G, Fillatre P (2023) Multiple-site decontamination in mechanically ventilated ICU patients: A real-life study. Infect Dis Now 53(3):104666. https://doi.org/10.1016/j.idnow.2023.104666
doi: 10.1016/j.idnow.2023.104666
pubmed: 36736667
Massart N, Dupin C, Mari A et al (2021) Clinician involvement for ventilator-associated pneumonia surveillance resulted in higher than expected incidence rate reported with implication for attributable mortality. Infect Dis (Lond) 53(2):154–157. https://doi.org/10.1080/23744235.2020.1839129
doi: 10.1080/23744235.2020.1839129
pubmed: 33103562
Blot SI, Taccone FS, Van den Abeele AM, Bulpa P et al (2012) A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med 186(1):56–64. https://doi.org/10.1164/rccm.201111-1978OC . (Erratum in: Am J Respir Crit Care Med. 2012 Oct 15;186(8):808)
doi: 10.1164/rccm.201111-1978OC
pubmed: 22517788
Verweij PE, Rijnders BJA, Brüggemann RJM et al (2020) Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion. Intensive Care Med 46(8):1524–1535. https://doi.org/10.1007/s00134-020-06091-6
doi: 10.1007/s00134-020-06091-6
pubmed: 32572532
pmcid: 7306567
Koehler P, Bassetti M, Chakrabarti A et al (2021) Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis 21(6):e149–e162. https://doi.org/10.1016/S1473-3099(20)30847-1
doi: 10.1016/S1473-3099(20)30847-1
pubmed: 33333012
Massart N, Camus C, Benezit F, Moriconi M, Fillatre P, Le Tulzo Y (2020) Incidence and risk factors for acquired colonization and infection due to extended-spectrum beta-lactamase-producing Gram-negative bacilli: a retrospective analysis in three ICUs with low multidrug resistance rate. Eur J Clin Microbiol Infect Dis 39(5):889–895. https://doi.org/10.1007/s10096-019-03800-y
doi: 10.1007/s10096-019-03800-y
pubmed: 31898797
pmcid: 7222057
Kreitmann L, Vasseur M, Jermoumi S, Perche J, Richard JC, Wallet F, Chabani M, Nourry E, Garçon P, Zerbib Y, Van Grunderbeeck N, Vinsonneau C, Preda C, Labreuche J, Nseir S (2023) Relationship between immunosuppression and intensive care unit-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter cohort study. Intensive Care Med 49(2):154–165. https://doi.org/10.1007/s00134-022-06954-0
doi: 10.1007/s00134-022-06954-0
pubmed: 36592202
Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Bruzzi de Carvalho F et al (2012) Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 38(12):1930–1945
doi: 10.1007/s00134-012-2695-9
pubmed: 23011531
Leone M, Bouadma L, Bouhemad B et al (2018) Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain Med 37(1):83–98. https://doi.org/10.1016/j.accpm.2017.11.006
doi: 10.1016/j.accpm.2017.11.006
pubmed: 29155054
Magiorakos AP, Srinivasan A, Carey RB et al (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18(3):268–281. https://doi.org/10.1111/j.1469-0691.2011.03570.x
doi: 10.1111/j.1469-0691.2011.03570.x
pubmed: 21793988
Harpaz R, Dahl RM, Dooling KL (2016) Prevalence of Immunosuppression Among US Adults, 2013. JAMA 316(23):2547–2548. https://doi.org/10.1001/jama.2016.16477
doi: 10.1001/jama.2016.16477
pubmed: 27792809
Azoulay É, Castro P, Maamar A, Metaxa V, de Moraes AG, Voigt L, Wallet F, Klouche K, Picard M, Moreau AS, Van De Louw A, Seguin A, Mokart D, Chawla S, Leroy J, Böll B, Issa N, Levy B, Hemelaar P, Fernandez S, Munshi L, Bauer P, Schellongowski P, Joannidis M, Moreno-Gonzalez G, Galstian G, Darmon M, Valade S, Nine-I investigators (2021) Outcomes in patients treated with chimeric antigen receptor T-cell therapy who were admitted to intensive care (CARTTAS): an international, multicentre, observational cohort study. Lancet Haematol 8(5):e355–e364. https://doi.org/10.1016/S2352-3026(21)00060-0
doi: 10.1016/S2352-3026(21)00060-0
pubmed: 33894170
Toffart AC, Meert AP, Wallet F, Gibelin A, Guisset O, Gonzalez F, Seguin A, Kouatchet A, Delaunay M, Debieuvre D, Duchemann B, Rousseau-Bussac G, Nyunga M, Grimaldi D, Levrat A, Azoulay E, Lemiale V (2023) ICU admission for solid cancer patients treated with immune checkpoint inhibitors. Ann Intensive Care 13(1):29. https://doi.org/10.1186/s13613-023-01122-z
doi: 10.1186/s13613-023-01122-z
pubmed: 37072645
pmcid: 10113402
Timsit JF, Sonneville R, Kalil AC, Bassetti M, Ferrer R, Jaber S, Lanternier F, Luyt CE, Machado F, Mikulska M, Papazian L, Pène F, Poulakou G, Viscoli C, Wolff M, Zafrani L, Van Delden C (2019) Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients. Intensive Care Med 45(5):573–591. https://doi.org/10.1007/s00134-019-05597-y
doi: 10.1007/s00134-019-05597-y
pubmed: 30911807
pmcid: 7079836
Florescu DF, Sandkovsky U, Kalil AC (2017) Sepsis and Challenging Infections in the Immunosuppressed Patient in the Intensive Care Unit. Infect Dis Clin North Am 31(3):415–434. https://doi.org/10.1016/j.idc.2017.05.009
doi: 10.1016/j.idc.2017.05.009
pubmed: 28687212
de Smet AM, Kluytmans JA, Cooper BS et al (2009) Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 360(1):20–31. https://doi.org/10.1056/NEJMoa0800394
doi: 10.1056/NEJMoa0800394
pubmed: 19118302
Roquilly A, Chanques G, Lasocki S, Foucrier A, Fermier B, De Courson H, Carrie C, Danguy des Deserts M, Gakuba C, Constantin JM, Lagarde K, Holleville M, Blidi S, Sossou A, Cailliez P, Monard C, Oudotte A, Mathieu C, Bourenne J, Isetta C, Perrigault PF, Lakhal K, Rouhani A, Asehnoune K, Guerci P, Tran Dinh A, Chousterman B, Cupaciu A, Dahyot-Fizelier C, Bellier R, Au Duong J, Mansour A, Morel J, Beauplet G, Vibet MA, Feuillet F, Sébille V, Leone M (2021) Implementation of French recommendations for the prevention and the treatment of hospital-acquired pneumonia: a cluster-randomized trial. Clin Infect Dis. 73(7):e1601-e1610. https://doi.org/10.1093/cid/ciaa1441
Camus C, Sauvadet E, Tavenard A et al (2016) Decline of multidrug-resistant Gram negative infections with the routine use of a multiple decontamination regimen in ICU. J Infect 73(3):200–209. https://doi.org/10.1016/j.jinf.2016.06.007
doi: 10.1016/j.jinf.2016.06.007
pubmed: 27373765
de Jonge E, Schultz MJ, Spanjaard L, Bossuyt PM, Vroom MB, Dankert J, Kesecioglu J (2003) Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 362(9389):1011–1016. https://doi.org/10.1016/S0140-6736(03)14409-1
doi: 10.1016/S0140-6736(03)14409-1
pubmed: 14522530
Azoulay E, Russell L, Van de Louw A, Metaxa V, Bauer P, Povoa P, Montero JG, Loeches IM, Mehta S, Puxty K, Schellongowski P, Rello J, Mokart D, Lemiale V, Mirouse A, Nine-i Investigators (2020) Diagnosis of severe respiratory infections in immunocompromised patients. Intensive Care Med 46(2):298–314. https://doi.org/10.1007/s00134-019-05906-5
doi: 10.1007/s00134-019-05906-5
pubmed: 32034433
pmcid: 7080052
Gangneux JP, Dannaoui E, Fekkar A, Luyt CE, Botterel F, De Prost N, Tadié JM, Reizine F, Houzé S, Timsit JF, Iriart X, Riu-Poulenc B, Sendid B, Nseir S, Persat F, Wallet F, Le Pape P, Canet E, Novara A, Manai M, Cateau E, Thille AW, Brun S, Cohen Y, Alanio A, Mégarbane B, Cornet M, Terzi N, Lamhaut L, Sabourin E, Desoubeaux G, Ehrmann S, Hennequin C, Voiriot G, Nevez G, Aubron C, Letscher-Bru V, Meziani F, Blaize M, Mayaux J, Monsel A, Boquel F, Robert-Gangneux F, Le Tulzo Y, Seguin P, Guegan H, Autier B, Lesouhaitier M, Pelletier R, Belaz S, Bonnal C, Berry A, Leroy J, François N, Richard JC, Paulus S, Argaud L, Dupont D, Menotti J, Morio F, Soulié M, Schwebel C, Garnaud C, Guitard J, Le Gal S, Quinio D, Morcet J, Laviolle B, Zahar JR, Bougnoux ME (2022) Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study. Lancet Respir Med 10(2):180–190. https://doi.org/10.1016/S2213-2600(21)00442-2
doi: 10.1016/S2213-2600(21)00442-2
pubmed: 34843666