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Observational Study
. 2023 Oct;42(10):1163-1172.
doi: 10.1007/s10096-023-04650-5. Epub 2023 Aug 19.

Prevention of ICU-acquired infection with decontamination regimen in immunocompromised patients: a pre/post observational study

Nicolas Massart  1 , Clarisse Dupin  2 , Eleonore Legris  3 , François Legay  4 , Anne Cady  5 , Pierre Fillatre  4 , Florian Reizine  6
Affiliations
Observational Study

Prevention of ICU-acquired infection with decontamination regimen in immunocompromised patients: a pre/post observational study

Nicolas Massart et al. Eur J Clin Microbiol Infect Dis. 2023 Oct.

Abstract

Purpose: 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.

Methods: 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.

Results: 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).

Conclusion: In conclusion, MSD appeared to be associated with improved outcomes in critically ill immunocompromised patients.

Keywords: Acquired infection; Bacteremia; Critical care; Immunodepression; Mortality; Pneumonia; Selective decontamination of the digestive tract.

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References

    1. 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 - PubMed
    1. 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 - PubMed
    1. 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 - PubMed
    1. 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 - PubMed
    1. 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 - PubMed - PMC

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