The effects of topical antibiotics on eradication and acquisition of 3rd-generation cephalosporin and carbapenem resistant Gram-negative bacteria in ICU patients; a post-hoc analysis from a multicenter cluster-randomized trial.

Abstract

OBJECTIVES\nTo quantify the effects of selective digestive tract decontamination (SDD) consisting of a mouth paste and gastro-enteral suspension, selective oropharyngeal decontamination with a mouth paste (SOD) and 1-2% chlorhexidine (CHX) mouthwash on eradication and acquisition of carriage of third generation cephalosporin-resistant Enterobacterales (3GCR-E) and carbapenem resistant Gram-negative bacteria (CR-GNB) in ICU patients.\n\n\nMETHODS\nNested cohort study within a cluster-randomized cross-over trial in 6 European countries and 13 ICUs with 8,665 patients. Eradication and acquisition during ICU stay of 3GCR-E and CR-GNB were investigated separately in the rectum and respiratory tract for the three interventions and compared to standard care (SC) using Cox-regression competing events analyses.\n\n\nRESULTS\nAdjusted cause specific hazard ratios (CSHR) for eradication of rectal carriage for SDD were 1.76 (95%CI 1.31-2.36) for 3GCR-E and 3.17 (95%CI 1.60-6.29) for CR-GNB, compared to SC. For the respiratory tract, adjusted CSHR for eradication of 3GCR-E were 1.47 (0.98-2.20) for SDD and 1.38 (0.92-2.06) for SOD, compared to SC and for eradication of CR-GNB these were 0.77 (0.41 - 1.45) for SDD and 0.81 (0.44-1.51) for SOD, compared to SC. Adjusted CSHRs for acquisition of rectal carriage during SDD (compared to SC) were 0.51 (0.40-0.64) for 3GCR-E and of 0.56 (0.40-0.78) for CR-GNB. Adjusted CSHRs for acquiring respiratory tract carriage with 3GCR-E, compared to SC, were 0.38 (0.28-0.50) for SDD and 0.55 (0.42-0.71) for SOD, and for CR-GNB 0.46 (0.33 - 0.64) during SDD and 0.60 (0.44-0.81) during SOD, respectively. SOD was not associated with eradication or acquisition of 3GCR-E and CR-GNB in the rectum.\n\n\nCONCLUSIONS\nAmongst mechanically ventilated ICU-patients, SDD was associated with more eradication and less acquisition of 3GCR-E and CR-GNB in the rectum than SC. SDD and SOD were associated with less acquisition of both 3GCR-E and CR-GNB, compared to SC, in the respiratory tract.