Nattawat Teerawattanapong1, Kirati Kengkla2, Piyameth Dilokthornsakul3, Surasak Saokaew2,3,4, Anucha Apisarnthanarak5, Nathorn Chaiyakunapruk3,4,6,7. 1. Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University. 2. Center of Health Outcomes Research and Therapeutic Safety, School of Pharmaceutical Sciences, University of Phayao, and. 3. Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. 4. School of Pharmacy, Monash University Malaysia, Selangor. 5. Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand. 6. School of Pharmacy, University of Wisconsin- Madison ; and. 7. School of Population Health, University of Queensland, Brisbane, Australia.
Abstract
BACKGROUND: This study evaluated the relative efficacy of strategies for the prevention of multidrug-resistant gram-negative bacteria (MDR-GNB) in adult intensive care units (ICUs). METHODS: A systematic review and network meta-analysis was performed; searches of the Cochrane Library, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) included all randomized controlled trials and observational studies conducted in adult patients hospitalized in ICUs and evaluating standard care (STD), antimicrobial stewardship program (ASP), environmental cleaning (ENV), decolonization methods (DCL), or source control (SCT), simultaneously. The primary outcomes were MDR-GNB acquisition, colonization, and infection; secondary outcome was ICU mortality. RESULTS: Of 3805 publications retrieved, 42 met inclusion criteria (5 randomized controlled trials and 37 observational studies), involving 62068 patients (median age, 58.8 years; median APACHE [Acute Physiology and Chronic Health Evaluation] II score, 18.9). The majority of studies reported extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and MDR Acinetobacter baumannii. Compared with STD, a 4-component strategy composed of STD, ASP, ENV, and SCT was the most effective intervention (rate ratio [RR], 0.05 [95% confidence interval {CI}, .01-.38]). When ENV was added to STD+ASP or SCT was added to STD+ENV, there was a significant reduction in the acquisition of MDR A. baumannii (RR, 0.28 [95% CI, .18-.43] and 0.48 [95% CI, .35-.66], respectively). Strategies with ASP as a core component showed a statistically significant reduction the acquisition of ESBL-producing Enterobacteriaceae (RR, 0.28 [95% CI, .11-.69] for STD+ASP+ENV and 0.23 [95% CI, .07-.80] for STD+ASP+DCL). CONCLUSIONS: A 4-component strategy was the most effective intervention to prevent MDR-GNB acquisition. As some strategies were differential for certain bacteria, our study highlighted the need for further evaluation of the most effective prevention strategies.
BACKGROUND: This study evaluated the relative efficacy of strategies for the prevention of multidrug-resistant gram-negative bacteria (MDR-GNB) in adult intensive care units (ICUs). METHODS: A systematic review and network meta-analysis was performed; searches of the Cochrane Library, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) included all randomized controlled trials and observational studies conducted in adult patients hospitalized in ICUs and evaluating standard care (STD), antimicrobial stewardship program (ASP), environmental cleaning (ENV), decolonization methods (DCL), or source control (SCT), simultaneously. The primary outcomes were MDR-GNB acquisition, colonization, and infection; secondary outcome was ICU mortality. RESULTS: Of 3805 publications retrieved, 42 met inclusion criteria (5 randomized controlled trials and 37 observational studies), involving 62068 patients (median age, 58.8 years; median APACHE [Acute Physiology and Chronic Health Evaluation] II score, 18.9). The majority of studies reported extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and MDR Acinetobacter baumannii. Compared with STD, a 4-component strategy composed of STD, ASP, ENV, and SCT was the most effective intervention (rate ratio [RR], 0.05 [95% confidence interval {CI}, .01-.38]). When ENV was added to STD+ASP or SCT was added to STD+ENV, there was a significant reduction in the acquisition of MDR A. baumannii (RR, 0.28 [95% CI, .18-.43] and 0.48 [95% CI, .35-.66], respectively). Strategies with ASP as a core component showed a statistically significant reduction the acquisition of ESBL-producing Enterobacteriaceae (RR, 0.28 [95% CI, .11-.69] for STD+ASP+ENV and 0.23 [95% CI, .07-.80] for STD+ASP+DCL). CONCLUSIONS: A 4-component strategy was the most effective intervention to prevent MDR-GNB acquisition. As some strategies were differential for certain bacteria, our study highlighted the need for further evaluation of the most effective prevention strategies.
Authors: Logan M Tillery; Kayleigh F Barrett; David M Dranow; Justin Craig; Roger Shek; Ian Chun; Lynn K Barrett; Isabelle Q Phan; Sandhya Subramanian; Jan Abendroth; Donald D Lorimer; Thomas E Edwards; Wesley C Van Voorhis Journal: Protein Sci Date: 2020-01-20 Impact factor: 6.725
Authors: Richard E Nelson; Vanessa W Stevens; Makoto Jones; Karim Khader; Marin L Schweizer; Eli N Perencevich; Michael A Rubin; Matthew H Samore Journal: Antimicrob Agents Chemother Date: 2018-10-24 Impact factor: 5.191
Authors: Jean-François Timsit; Matteo Bassetti; Olaf Cremer; George Daikos; Jan de Waele; Andre Kallil; Eric Kipnis; Marin Kollef; Kevin Laupland; Jose-Artur Paiva; Jesús Rodríguez-Baño; Étienne Ruppé; Jorge Salluh; Fabio Silvio Taccone; Emmanuel Weiss; François Barbier Journal: Intensive Care Med Date: 2019-01-18 Impact factor: 17.440