Ecological effects of selective oral decontamination on multidrug-resistance bacteria acquired in the intensive care unit: a case–control study over 5 years,Intensive Care Medicine

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Ecological effects of selective oral decontamination on multidrug-resistance bacteria acquired in the intensive care unit: a case–control study over 5 years
Intensive Care Medicine ( IF 27.1 ) Pub Date : 2022-08-11 , DOI: 10.1007/s00134-022-06826-7
Boacheng Wang ₁ , Josef Briegel ₁ , Wolfgang A Krueger ₂ , Rika Draenert ₃ , Jette Jung _{3,

4} , Alexandra Weber ₃ , Johannes Bogner ₅ , Sören Schubert ₄ , Uwe Liebchen ₁ , Sandra Frank ₁ , Michael Zoller ₁ , Michael Irlbeck ₁ , Ludwig Ney ₁ , Thomas Weig ₁ , Ludiwg Hinske ₁ , Sebastian Niedermayer ₁ , Erich Kilger ₁ , Patrick Möhnle ₁ , Beatrice Grabein ₆

Affiliation

Purpose

This case–control study investigated the long-term evolution of multidrug-resistant bacteria (MDRB) over a 5-year period associated with the use of selective oropharyngeal decontamination (SOD) in the intensive care unit (ICU). In addition, effects on health care-associated infections and ICU mortality were analysed.

Methods

We investigated patients undergoing mechanical ventilation > 48 h in 11 adult ICUs located at 3 campuses of a university hospital. Administrative, clinical, and microbiological data which were routinely recorded electronically served as the basis. We analysed differences in the rates and incidence densities (ID, cases per 1000 patient-days) of MDRB associated with SOD use in all patients and stratified by patient origin (outpatient or inpatient). After propensity score matching, health-care infections and ICU mortality were compared.

Results

5034 patients were eligible for the study. 1694 patients were not given SOD. There were no differences in the incidence density of MDRB when SOD was used, except for more vancomycin-resistant Enterococcus faecium (0.72/1000 days vs. 0.31/1000 days, p < 0.01), and fewer ESBL-producing Klebsiella pneumoniae (0.22/1000 days vs. 0.56/1000 days, p < 0.01). After propensity score matching, SOD was associated with lower incidence rates of ventilator-associated pneumonia and death in the ICU but not with ICU-acquired bacteremia or urinary tract infection.

Conclusions

Comparisons of the ICU-acquired MDRB over a 5-year period revealed no differences in incidence density, except for lower rate of ESBL-producing Klebsiella pneumoniae and higher rate of vancomycin-resistant Enterococcus faecium with SOD. Incidence rates of ventilator-associated pneumonia and death in the ICU were lower in patients receiving SOD.

中文翻译：

选择性口腔去污对重症监护病房获得的多重耐药菌的生态影响：一项超过 5 年的病例对照研究

目的

本病例对照研究调查了与在重症监护病房 (ICU) 中使用选择性口咽去污 (SOD) 相关的多重耐药菌 (MDRB) 在 5 年期间的长期演变。此外，还分析了对医疗保健相关感染和 ICU 死亡率的影响。

方法

我们调查了位于大学医院 3 个校区的 11 个成人 ICU 中接受机械通气 > 48 小时的患者。常规电子记录的管理、临床和微生物数据作为基础。我们分析了所有患者中与 SOD 使用相关的 MDRB 的发生率和发病密度（ID，每 1000 患者日病例数）的差异，并按患者来源（门诊患者或住院患者）进行分层。在倾向评分匹配后，比较了医疗保健感染和 ICU 死亡率。

结果

5034 名患者符合研究条件。1694 名患者未给予 SOD。使用 SOD 时 MDRB 的发生密度没有差异，除了更多的耐万古霉素屎肠球菌（0.72/1000 天 vs. 0.31/1000 天，p < 0.01）和更少的产 ESBL肺炎克雷伯菌（0.22/ 1000 天） 1000 天对比 0.56/1000 天，p < 0.01）。倾向评分匹配后，SOD 与 ICU 中较低的呼吸机相关性肺炎和死亡率发生率相关，但与 ICU 获得性菌血症或尿路感染无关。