The effects of topical antibiotics on eradication and acquisition of third-generation cephalosporin and carbapenem-resistant Gram-negative bacteria in ICU patients; a post hoc analysis from a multicentre cluster-randomized trial
Por:
Plantinga, NL, Wittekamp, BHJ, Brun-Buisson, C, Bonten, MJM, Cooper, B.S., Coll P., López-Contreras J., Mancebo, J, Wise, M.P., Morgan, M.P.G., Depuydt, P., Boelens, J., Dugernier, T., Verbelen, V., Jorens, P.G., Verbrugghe, W., Malhotra-Kumar, S., Damas, P., Meex, C., van den Abeele, A.M., Esteves, F., de Matos, A. F.G.P., Torres, A., Mendez, S.F., Gomez, A.V., Tomic, V., Sifrer, F., Tello, E.V., Ramos, JR, Aragao, I., Santos, C., Sperning, R.H.M., Coppadoro, P., Nardi, G.
Publicada:
1 abr 2020
Resumen:
Objectives: The aim was to quantify the effects of selective digestive tract decontamination (SDD) consisting of a mouth paste and gastro-enteral suspension, selective oropharyngeal decontamination with a mouth paste (SOD) and 1-2% chlorhexidine (CHX) mouthwash on eradication and acquisition of carriage of third-generation cephalosporin-resistant Enterobacterales (3GCR-E) and carbapenem-resistant Gram-negative bacteria (CR-GNB) in Intensive Care Unit (ICU) patients.
Methods: This was a nested cohort study within a cluster-randomized cross-over trial in six European countries and 13 ICUs with 8665 patients. Eradication and acquisition during ICU stay of 3GCR-E and CRGNB were investigated separately in the rectum and respiratory tract for the three interventions and compared with standard care (SC) using Cox-regression competing events analyses.
Results: Adjusted cause specific hazard ratios (CSHR) for eradication of rectal carriage for SDD were 1.76 (95% CI 1.31-2.36) for 3GCR-E and 3.17 (95% CI 1.60-6.29) for CR-GNB compared with SC. For the respiratory tract, adjusted CSHR for eradication of 3GCR-E were 1.47 (0.98-2.20) for SDD and 1.38 (0.92 -2.06) for SOD compared with SC, and for eradication of CR-GNB these were 0.77 (0.41- 1.45) for SDD and 0.81 (0.44-1.51) for SOD, compared with SC. Adjusted CSHRs for acquisition of rectal carriage during SDD (compared with SC) were 0.51 (0.40-0.64) for 3GCR-E and of 0.56 (0.40-0.78) for CR-GNB. Adjusted CSHRs for acquiring respiratory tract carriage with 3GCR-E compared with SC were 0.38 (0.28-0.50) for SDD and 0.55 (0.42-0.71) for SOD, and for CR-GNB 0.46 (0.33-0.64) during SDD and 0.60 (0.44-0.81) during SOD, respectively. SOD was not associated with eradication or acquisition of 3GCR-E and CR-GNB in the rectum.
Conclusions: Among mechanically ventilated ICU patients, SDD was associated with more eradication and less acquisition of 3GCR-E and CR-GNB in the rectum than SC. SDD and SOD were associated with less acquisition of both 3GCR-E and CR-GNB than SC in the respiratory tract. (C) 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Filiaciones:
Plantinga, NL:
Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Dept Med Microbiol, Utrecht, Netherlands
Wittekamp, BHJ:
Univ Med Ctr Utrecht, Intens Care Ctr, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands
Brun-Buisson, C:
Univ Paris Est Creteil, Med ICU & Infect Control Unit, Hop Henri Mondor, Creteil, France
Bonten, MJM:
Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Dept Med Microbiol, Utrecht, Netherlands
Cooper, B.S.:
Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
Coll P.:
Hospital de Sant Pau-Universitat Autònoma de Barcelona, Spain
López-Contreras J.:
Hospital de Sant Pau-Universitat Autònoma de Barcelona, Spain
Mancebo, J:
Hospital de Sant Pau-Universitat Autònoma de Barcelona, Spain
Wise, M.P.:
University Hospital of Wales, Cardiff, United Kingdom
Morgan, M.P.G.:
University Hospital of Wales, Cardiff, United Kingdom
Depuydt, P.:
Ghent University Hospital, Belgium
Boelens, J.:
Ghent University Hospital, Belgium
Dugernier, T.:
Clinique Saint Pierre, Ottignies, Belgium
Verbelen, V.:
Clinique Saint Pierre, Ottignies, Belgium
Jorens, P.G.:
Antwerp University Hospital, University of Antwerp, Belgium
Verbrugghe, W.:
Antwerp University Hospital, University of Antwerp, Belgium
Malhotra-Kumar, S.:
Antwerp University Hospital, University of Antwerp, Belgium
Damas, P.:
CHU Liège, Belgium
Meex, C.:
AZ Sint Jan Bruges, Belgium
van den Abeele, A.M.:
Saint-Lucas Hospital Ghent, Belgium
Esteves, F.:
Centro Hospitalar de Trás-os-Montes os Montes e Alto Douro, Vila Real, Portugal
de Matos, A. F.G.P.:
Centro Hospitalar de Trás-os-Montes os Montes e Alto Douro, Vila Real, Portugal
Torres, A.:
Hospital Clinic of Barcelona, Spain
Mendez, S.F.:
Hospital Clinic of Barcelona, Spain
Gomez, A.V.:
Hospital Clinic of Barcelona, Spain
Tomic, V.:
University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
Sifrer, F.:
University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
Tello, E.V.:
Hospital Universitario La Fe, Valencia, Spain
Ramos, JR:
Hospital de Sant Pau-Universitat Autònoma de Barcelona, Spain
Aragao, I.:
Hospital Santo Antonio – Centro Hospitalar do Porto (CHP), Portugal
Santos, C.:
Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
Sperning, R.H.M.:
Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
Coppadoro, P.:
Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
Nardi, G.:
Ospedale Infermi RIMINI – AUSL della Romagna, Italy
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