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Multiple-site decontamination regimen decreases acquired infection incidence in mechanically ventilated COVID-19
Nicolas Massart1, Florian Reizine2,3, Pierre Fillatre4
1Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France. nicolasmassart@hotmail.fr.
Background:
Among strategies that aimed to prevent acquired infections (AIs), selective decontamination regimens have been poorly studied in the COVID-19 setting. We assessed the impact of a multiple-site decontamination (MSD) regimen on the incidence of bloodstream infections (BSI) and ventilator-associated pneumonia (VAP) in COVID-19 patients receiving mechanical ventilation.
Methods:
We performed an ancillary analysis of a multicenter retrospective observational study in 15 ICUs in western France. In addition to standard-care (SC), 3 ICUs used MSD, a variant of selective digestive decontamination, which consists of the administration of topical antibiotics four times daily in the oropharynx and the gastric tube, chlorhexidine body wash and a 5-day nasal mupirocin course. AIs were compared between the 3 ICUs using MSD (MSD group) and the 12 ICUs using SC.
Results:
During study period, 614 of 1158 COVID-19 patients admitted in our ICU were intubated for at least 48 h. Due to missing data in 153 patients, 461 patients were finally included of whom 89 received MSD. There were 34 AIs in the MSD group (2117 patient-days), as compared with 274 AIs in the SC group (8957 patient-days) (p < 0.001). MSD was independently associated with a lower risk of AI (IRR = 0.56 [0.38-0.83]; p = 0.004) (Table 2). When the same model was used for each site of infection, MSD remained independently associated with a lower risk of VAP (IRR = 0.52 [0.33-0.89]; p = 0.005) but not of BSI (IRR = 0.58, [0.25-1.34], p = 0.21). Hospital mortality was lower in the MSD group (16.9% vs 30.1%, p = 0.017).
Conclusions:
In ventilated COVID-19 patients, MSD was independently associated with lower AI incidence.
Insights
Multiple-site decontamination (MSD) significantly reduced acquired infections (AIs) in mechanically ventilated COVID-19 patients. This strategy also lowered the incidence of ventilator-associated pneumonia (VAP) and hospital mortality.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Selective decontamination regimens are understudied in COVID-19 critical care.
- Acquired infections (AIs) pose a significant threat to mechanically ventilated patients.
- Assessing interventions to reduce AIs in COVID-19 is crucial.
Purpose of the Study:
- To evaluate the impact of a multiple-site decontamination (MSD) regimen on AI incidence.
- To compare AI rates between COVID-19 patients receiving MSD and standard care (SC).
- To determine if MSD reduces bloodstream infections (BSI) and ventilator-associated pneumonia (VAP).
Main Methods:
- Ancillary analysis of a multicenter retrospective observational study.
- Comparison of 3 ICUs using MSD (topical antibiotics, chlorhexidine wash, nasal mupirocin) versus 12 ICUs using SC.
- Inclusion of 461 mechanically ventilated COVID-19 patients with at least 48 hours of ventilation.
Main Results:
- MSD was associated with a significant reduction in overall AI incidence (IRR = 0.56; P = 0.004).
- MSD independently reduced VAP risk (IRR = 0.52; P = 0.005) but not BSI risk (IRR = 0.58; P = 0.21).
- Hospital mortality was lower in the MSD group (16.9%) compared to the SC group (30.1%; P = 0.017).
Conclusions:
- Multiple-site decontamination (MSD) is independently associated with a lower incidence of acquired infections in ventilated COVID-19 patients.
- MSD demonstrates efficacy in reducing ventilator-associated pneumonia.
- The findings suggest MSD as a potentially valuable strategy for infection control in this patient population.
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