Selective decontamination regimens in French ICUs: association with reduced infection and resistance emergence

Despite randomized controlled trials with favorable results, few intensive care units (ICUs) implemented selective decontamination (SD) for ICU-acquired infection prevention. We aimed to evaluate, SD implementation and associated-effects in a large network of French ICUs.

This study was conducted using the healthcare-associated infection surveillance cohort "REA-REZO" involving 193 participating ICUs. All patients receiving invasive mechanical ventilation for > 24 h were included. In addition to standard of care (SOC), six ICUs applied a SD strategy during the study period. The primary endpoint was the rate of ICU-acquired infection. A propensity-score matched analysis was conducted using non-parsimonious regression model. The secondary endpoint was the rate of colonization by multidrug resistant organisms (MDRO) during the ICU stay.

Among 81,661 patients with invasive mechanical ventilation for longer than 24 h, 2727 patients receiving SD were matched with 2 727 receiving SOC. The ICU-acquired infection incidence was lower in the SD group as compared with the SOC group (Incidence Rate Ratio = 0.66 [0.60-0.73]; p < 0.001) although the ICU mortality was similar (31.9% vs 32.5%, respectively p = 0.689). Acquisition of MDRO was lower in the SD group than in the SOC group (40 (1.5%) patients vs. 139 (5.1%) patients p < 0.001).

These results showed that a strategy of SD was associated with reduced ICU-acquired infection incidence and decreased emergence of MDRO, while the mortality was not affected.