Longitudinal evaluation of a multidisciplinary infection prevention and control bundle in a high AMR prevalence ICU

Antimicrobial resistance is a major threat in intensive care units (ICUs). We evaluated changes associated with a multidisciplinary infection prevention and control (IPC) bundle in a high-AMR-prevalence setting.

This longitudinal quasi-experimental ICU study (2022-2024) involved sequential, cumulative implementation of a bundle integrating infection prevention, rapid diagnostics and colonization screening, antimicrobial stewardship, and surveillance with data feedback.

Hand hygiene compliance increased from 29.5% at baseline to 64.6% during sustainment, while PPE compliance increased from 67.1% to 73.3% after monitoring was introduced. Piperacillin/tazobactam consumption increased (+3.33 DDD/100 patient-days per phase; 95% CI, 1.92-4.73), whereas colistin (-5.85; 95% CI, -9.17 to -2.54) and tigecycline (-2.50; 95% CI, -4.25 to -0.75) decreased. Klebsiella pneumoniae meropenem resistance decreased (OR per phase, 0.54; 95% CI, 0.43-0.69), whereas colistin resistance showed a borderline increase in Acinetobacter baumannii (OR, 1.28; 95% CI, 1.00-1.65). ICU-acquired bloodstream infections decreased across implementation phases for CRE (IRR per phase, 0.37; 95% CI, 0.26-0.51) and CRAB (IRR, 0.56; 95% CI, 0.46-0.68), as did CLABSI (IRR, 0.64; 95% CI, 0.56-0.73) and ICU-acquired rectal colonization with CRE (IRR, 0.73; 95% CI, 0.63-0.84) and CRAB (IRR, 0.78; 95% CI, 0.70-0.87), whereas CRPA ICU-acquired colonization increased (IRR, 1.56; 95% CI, 1.32-1.85).

IPC bundle implementation was followed by improved IPC practices and reductions in several ICU-acquired infections and colonization outcomes; continued surveillance and stewardship are essential.