Efficacy of a hospital policy of selective digestive decontamination for carbapenem-resistant Enterobacterales carriers: prospective before–after study

Bar-Yoseph, Haggai; Lulu, C; Shklar, Shlomit; Korytny, Alexander; Dar, Razi Even; Daoud, Haneen; Hussein, Khetam; Bar-Lavie, Yaron; Jabareen, A; Geffen, Yuval; Investigators, Shaper

doi:10.1016/j.jhin.2020.08.007

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…Until such uncertainties are addressed, infection prevention and control measures are essential to reduce the spread of MDR-GNB. These include, but are not limited to: (a) compliance with standard and contact precautions [36,37] (i.e., hand hygiene and appropriate use of gloves and gowns); (b) active microbiological surveillance [38]; (c) reduction in device use to prevent catheter-associated infection and ventilator-associated pneumonia [39]; (d) adequate cleaning and disinfection of environmental surfaces [40] and reusable devices [41], especially duodenoscopes [42]; (e) antimicrobial stewardship, with particular emphasis on surgical antimicrobial prophylaxis [43]; and (f) selective digestive decontamination [44], with promising results that should, however, be interpreted with caution [45]. This will not be an easy endeavour, as the challenges to tackling antimicrobial resistance will be unprecedented in the aftermath of the COVID-19 pandemic, due to changes in antimicrobial usage and availability [46].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit

Fernández-Martínez

Cárcel-Fernández

Fuente-Martos

et al. 2022

IJERPH

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Multidrug-resistant Gram-negative bacteria (MDR-GNB) are microorganisms that have acquired resistance to extended-spectrum antibacterials and constitute an emerging threat to public health. Although carriers are an important source of transmission in healthcare settings, data about risk factors for MDR-GNB carriage are limited. Therefore, we aimed to identify risk factors for MDR-GNB carriage upon intensive care unit (ICU) admission and to optimise screening strategies. We conducted a case–control study. Admissions of adult patients to the ICU of a 1000-bed hospital during a year were included. We collected sociodemographic, clinical and microbiological data and performed a multivariate logistic regression model. A total of 1342 patients resulted in 1476 episodes of ICU admission, 91 (6.2%) of whom harboured MDR-GNB (38.5% women; median age 63.9 years). The most frequently isolated pathogens were Escherichia coli (57%) and Klebsiella pneumoniae (16%). The most frequent resistance mechanism was production of extended-spectrum beta lactamases. MDR-GNB carriage was associated to liver cirrhosis (OR 6.54, 95% CI 2.17–19.17), previous MDR-GNB carriage (OR 5.34, 1.55–16.60), digestive surgery (OR 2.83, 1.29–5.89) and length of hospital stay (OR 1.01 per day, 1.00–1.03). Several risk factors for MDR-GNB carriage upon admission to a high-risk setting were identified; the main comorbidity was liver cirrhosis.

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