Infection prevention strategies for carbapenem-resistant and ESBL-producing gram-negative bacteria in intensive care...

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Public Health

Background:

• Healthcare-associated infections (HAIs) caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) are a significant problem in intensive care units (ICUs).
• Standard infection prevention and control (IPC) strategies are often augmented with multimodal bundles, but the efficacy of individual components is not well understood.

Purpose of the Study:

• To systematically review and meta-analyze the effectiveness of infection prevention strategies in reducing the acquisition of MDR-GNB in adult ICUs.
• To compare the effects of various multimodal IPC interventions against standard precautions.

Main Methods:

• A systematic review of interventional studies in adult ICUs was conducted.
• An exploratory component network meta-analysis evaluated multimodal interventions.
• The primary outcome was the acquisition of carbapenem-resistant Gram-negative bacilli or extended spectrum β-lactamase-producing Enterobacterales.

Main Results:

• Seventeen studies were included, with 12 contributing to the network meta-analysis (36,264 patients).
• Two multimodal strategies showed reduced acquisition: active surveillance with chlorhexidine bathing, contact precautions, and enhanced environmental cleaning (RR 0.34) and chlorhexidine bathing with decolonization (RR 0.39).
• No single IPC component demonstrated a significant independent effect; overall evidence certainty was low.

Conclusions:

• Multimodal IPC strategies may decrease the acquisition of MDR-GNB in ICUs.
• Isolated IPC interventions beyond standard precautions have uncertain benefits.
• Findings require cautious interpretation due to clinical heterogeneity and low evidence certainty.