Multiple Site Decontamination in ICU patients: a real life pre/post study

Abstract

Abstract Background: Decontamination regimen decreases acquired infection (AI) incidence but remains controversial, mostly because it contained a course of intravenous antibiotic. Multiple site decontamination (MSD), that do not included systemic antibiotics, has been less studied but is associated with lower risk of ventilator associated pneumonia (VAP), bloodstream infection (BSI) and multidrug resistant micro-organisms (MDRO) acquisition. We aimed to confirm these favorable outcomes. Methods: A prospective pre/post-observational study was conducted in 5 ICUs in western France. Among them, 4 implemented MSD whereas the last one applied standard care (SC) during all study period. Patients who required intubation were eligible for study and divided into two groups: MSD group if they were admitted in an ICU that already implemented MSD and SC group otherwise. Primary objective was AI incidence. Results: 1346 patients were available for analysis (334 in the MSD and 1012 patients in the SC group). In a multivariable Poisson regression model, MSD was independently associated with a decreased incidence of AI (IRR = 0.33; 95%CI [0.18-0.60] p<0.001). A non-parsimonious propensity-score matching resulted in 334 patient-pairs with well-balanced baseline characteristics. There were a lower incidence of AI (6.3% vs 20.7% p<0.001), VAP (3.6% vs 16.2% p <0.001) and BSI (3.0% vs 7.2% p = 0.029) in the MSD group as compared with the SC group. Five patients (1.5%) and 11 (3.3%) acquired a MDRO respectively (p=0.206).Conclusion: MSD is associated with a decrease risk of AI, VAP and BSI with no increase in MDRO acquisition.