Length of intensive care unit stay and the apparent efficacy of antimicrobial-based versus non-antimicrobial-based ventilator pneumonia prevention interventions within the Cochrane review database

Hurley, James C.

doi:10.1016/j.jhin.2023.07.018

Cited by 6 publications

(4 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The high S. aureus VAP and S. aureus BSI incidences within the concurrent control groups of antibiotic-BDI studies noted here as a spill-over effect, which is as previously noted for several end points [8,[17][18][19]23,43,45,46], would conflate the apparent prevention effect.…”

Section: Discussionsupporting

confidence: 81%

“…The literature search used here is as described previously [23]. Cochrane reviews and other systematic reviews were used as the primary source of studies, with additional studies being found by snowball sampling using the "Related articles" function within Google Scholar [9][10][11][12][13][24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

Section: Study Selection and Decant Of Groupsmentioning

confidence: 99%

“…Thirdly, there is the unresolved issue of spillover effects to concurrent patients within the ICU not receiving decontamination which might also 'drive' event rates [17][18][19]. This is especially concerning for high quality studies of decontamination interventions with concurrent controls [23].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rebound Inverts the Staphylococcus aureus Bacteremia Prevention Effect of Antibiotic Based Decontamination Interventions in ICU Cohorts with Prolonged Length of Stay

Hurley

2024

Antibiotics

View full text Add to dashboard Cite

Could rebound explain the paradoxical lack of prevention effect against Staphylococcus aureus blood stream infections (BSIs) with antibiotic-based decontamination intervention (BDI) methods among studies of ICU patients within the literature? Two meta-regression models were applied, each versus the group mean length of stay (LOS). Firstly, the prevention effects against S. aureus BSI [and S. aureus VAP] among 136 studies of antibiotic-BDI versus other interventions were analyzed. Secondly, the S. aureus BSI [and S. aureus VAP] incidence in 268 control and intervention cohorts from studies of antibiotic-BDI versus that among 165 observational cohorts as a benchmark was modelled. In model one, the meta-regression line versus group mean LOS crossed the null, with the antibiotic-BDI prevention effect against S. aureus BSI at mean LOS day 7 (OR 0.45; 0.30 to 0.68) inverted at mean LOS day 20 (OR 1.7; 1.1 to 2.6). In model two, the meta-regression line versus group mean LOS crossed the benchmark line, and the predicted S. aureus BSI incidence for antibiotic-BDI groups was 0.47; 0.09–0.84 percentage points below versus 3.0; 0.12–5.9 above the benchmark in studies with 7 versus 20 days mean LOS, respectively. Rebound within the intervention groups attenuated and inverted the prevention effect of antibiotic-BDI against S. aureus VAP and BSI, respectively. This explains the paradoxical findings.

show abstract

Section: Discussionsupporting

confidence: 81%

Section: Study Selection and Decant Of Groupsmentioning

confidence: 99%

See 1 more Smart Citation

Rebound Inverts the Staphylococcus aureus Bacteremia Prevention Effect of Antibiotic Based Decontamination Interventions in ICU Cohorts with Prolonged Length of Stay

Hurley

2024

Antibiotics

View full text Add to dashboard Cite

show abstract

“…48 Length of stay behaves differently as a confounder of study effect size for the non-antimicrobial versus antimicrobial Cochrane review RCCT's. 49…”

Section: Open Accessmentioning

confidence: 99%

Indirect (herd) effects of topical antibiotic prophylaxis and oral care versus non-antimicrobial methods increase mortality among ICU patients: realigning Cochrane review data to emulate a three-tier cluster randomised trial

Hurley

2023

BMJ Open

View full text Add to dashboard Cite

ObjectiveThis study aimed to estimate the direct effects to recipients and indirect (herd) effects to non-recipients of each of topical antibiotic prophylaxis (TAP) and oral care methods on patient mortality within randomised concurrent controlled trials (RCCT) using Cochrane review data.DesignControl and intervention groups from 209 RCCTs of TAP (tier 3), oral care (tier 2) each versus non-antimicrobial (tier 1) ventilator-associated pneumonia (VAP) prevention interventions arranged to emulate a three-tiered cluster randomised trial (CRT). Eligible RCCTs were those including ICU patients with >50% of patients receiving >24 hours of mechanical ventilation (MV) with mortality data available as abstracted in 13 Cochrane reviews.ExposuresDirect and indirect exposures to either TAP or oral care within RCCTs versus non-antimicrobial VAP prevention interventions.Main outcomes and measuresThe ICU mortality within control and intervention groups, respectively, within RCCTs of either TAP or oral care versus that within non-antimicrobial VAP prevention RCCTs serving as benchmark.ResultsThe ICU mortality was 23.9%, 23.0% and 20.3% for intervention groups and 28.7%, 25.5% and 19.5% for control groups of RCCTs of TAP (tier 1), oral care (tier 2) and non-antimicrobial (tier 3) methods of VAP prevention, respectively. In a random effects meta-regression including late mortality data and adjusting for group mean age, year of study publication and MV proportion, the direct effect of TAP and oral care versus non-antimicrobial methods were 1.04 (95% CI 0.78 to 1.30) and 1.1 (95% CI 0.77 to 1.43) whereas the indirect effects were 1.39 (95% CI 1.03 to 1.74) and 1.26 (95% CI 0.89 to 1.62), respectively.ConclusionsIndirect (herd) effects from TAP and oral care methods on mortality are stronger than the direct effects as made apparent by the three-tiered CRT. These indirect effects, being harmful to concurrent control groups by increasing mortality, perversely inflate the appearance of benefit within RCCTs.

show abstract

Adult intensive care unit nurses' knowledge of and compliance barriers to evidence‐based guidelines for prevention of ventilator‐associated pneumonia: A cross‐sectional survey

Yao,

Xu,

et al. 2024

Nursing in Critical Care

View full text Add to dashboard Cite

BackgroundVentilator‐associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICUs) and is a common cause of morbidity and mortality in intensive care patients. Previous studies show that insufficient knowledge and compliance barriers among nurses affect pneumonia. There have been no investigations into intensive care nurses' knowledge and compliance barriers to evidence‐based guidelines (EBGs) for VAP prevention in county‐level hospitals in China.AimsTo explore adult ICU nurses' knowledge and compliance barriers to EBGs for preventing VAP in county‐level hospitals in Hunan Province, China, examine the correlation between knowledge and compliance barriers, and analyse associated factors.Study DesignA cross‐sectional electronic survey was conducted to focus on nurses' knowledge of and compliance barriers to EBGs for preventing VAP.ResultsA total of 386 valid questionnaires were collected, with a response rate of 97.47% (386/396 = 97.47%). The median scores for nurses' knowledge (out of 9) and compliance barriers (out of 8) to EBGs for preventing VAP were 7 (interquartile range: 5–8) and 3 (interquartile range: 2–4), respectively. Knowledge was negatively associated with compliance barriers (r = −0.437, p < .01). The results of the multiple linear regression analysis showed that hospital level, age, nurses' attendance at VAP training and years of experience in ICUs were related to the level of knowledge. Nurses' attendance at VAP training, age and years of experience in ICUs were associated with the level of compliance barriers.ConclusionsIntensive care nurses have satisfactory knowledge of EBGs for preventing VAP, but compliance barriers can be reduced. Better knowledge helps reduce the barriers to compliance among nurses.Relevance to Clinical PracticeNurse managers and nurse educators are suggested to examine nurses' knowledge and compliance barriers to EBGs for preventing VAP, develop personalized training plans, promote continuous education based on the latest EBGs and raise the nurse–patient ratio reasonably.

show abstract

Length of intensive care unit stay and the apparent efficacy of antimicrobial-based versus non-antimicrobial-based ventilator pneumonia prevention interventions within the Cochrane review database

Cited by 6 publications

References 26 publications

Rebound Inverts the Staphylococcus aureus Bacteremia Prevention Effect of Antibiotic Based Decontamination Interventions in ICU Cohorts with Prolonged Length of Stay

Rebound Inverts the Staphylococcus aureus Bacteremia Prevention Effect of Antibiotic Based Decontamination Interventions in ICU Cohorts with Prolonged Length of Stay

Indirect (herd) effects of topical antibiotic prophylaxis and oral care versus non-antimicrobial methods increase mortality among ICU patients: realigning Cochrane review data to emulate a three-tier cluster randomised trial

Adult intensive care unit nurses' knowledge of and compliance barriers to evidence‐based guidelines for prevention of ventilator‐associated pneumonia: A cross‐sectional survey

Contact Info

Product

Resources

About