Prevention of acquired infections in intubated patients with the combination of two decontamination regimens

Camus, Christophe; Bellissant, Éric; Sebille, Véronique; Perrotin, D.; Garo, B.; Legras, Annick; Renault, Anne; Corre, Pascal Le; Donnio, Pierre-Yves; Gacouin, Arnaud; Tulzo, Yves Le; Thomas, R.

doi:10.1097/01.ccm.0000152224.01949.01

Cited by 87 publications

(97 citation statements)

References 33 publications

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“…The therapy for extraintestinal E. coli infections does consist of antibiotics. However, antibiotics have the disadvantage of adverse effects, safety problems during pregnancy and selective pressure that can induce the emergence of resistant strains (Camus et al 2005;Vincent 2003). The rates of antibiotic resistance among E. coli strains have increased greatly over the past two decades, encouraging the search for novel antimicrobial strategies (Nickel 2007;Moreno et al 2006).…”

Section: Introductionmentioning

confidence: 99%

Lactoferrin: an iron-binding antimicrobial protein against Escherichia coli infection

et al. 2011

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Escherichia coli (E. coli) are the most common aerobic gram-negative bacilli in a normal intestinal tract. They cause most of the intra-abdominal infections, wound infections associated with abdominal surgery, and septicemia. Most of these infections are of endogenous intestinal origin. Lactoferrin (LF) is an iron-binding glycoprotein found in milk and various external secretions. This protein has been found to have a number of biological functions, including antimicrobial, anti-cancer, antioxidant, and immunomodulatory effects. Partial degradation of LF by pepsin can give rise to peptides termed lactoferricin (LFcin) with more potent antimicrobial activity. LF and LFcin have been shown to inhibit the growth of a number of pathogenic bacteria (including E. coli and antibiotic-resistant strains), fungi, and even viruses in both in vitro and in vivo studies. We previously demonstrated that both recombinant porcine LF (pLF) produced from yeast and a synthetic 20-residue porcine LFcin peptide exhibit antimicrobial activity in vitro. In one of our recent studies, we performed pathogen challenges, including pathogenic E. coli, Staphylococcus aureus and Candida albicans, of the digestive tract of a transgenic milk-fed animal model. The results showed that LF has broad spectrum antimicrobial activity in the digestive tract and protects the mucosa of the small intestine from injury. Our following study also revealed that pLF as a feedstuff additive enhances avian immunity, including antibody formation and cell-mediated immunity. All of these results suggest that LF could be a novel natural protein in the treatment and prevention of infections with E. coli or antibiotic-resistant bacteria strains.

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Section: Introductionmentioning

confidence: 99%

Lactoferrin: an iron-binding antimicrobial protein against Escherichia coli infection

et al. 2011

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“…We were not tracking catheter-associated urinary tract infection rates in the preintervention period. However, for units with high rates of any of these infections, CHG bathing provides a reasonable intervention to reduce such infections, 4,[22][23][24][25][26][27] although not all studies showed reductions in infection rates. 28 Compliance with nasal swab screening and hand hygiene are essential measures to analyze the impact of CHG bathing.…”

Section: Discussionmentioning

confidence: 99%

“…Soon after that study, many hospitals decided to abandon bath basins for ICU bathing in favor of using washcloths impregnated with 2% CHG. Historically, several studies 11,[15][16][17][18][20][21][22]27 of the effects of CHG bathing used 4% CHG in bath basins or showering; other studies 4,10,[12][13][14][23][24][25][26]28 used cloths impregnated with 2% CHG. Our surgical/ burn/trauma ICU staff nurses willingly tried the CHGimpregnated cloths before this study but were not satisfied with their performance and preferred the bath-basin method for patient bathing. Since the report of bath basin contamination by Johnson et al, 3 Powers and colleagues 31 studied the presence of bacterial contaminants in wash basins when CHG solution was used in place of standard soap and water to wash patients.…”

Section: Discussionmentioning

confidence: 99%

“…4,[11][12][13]16,17 Bathing with CHG also reduces MRSA skin colonization in known MRSA carrier patients during their treatment. [18][19][20][21] Several studies showed that bathing with CHG and nasal administration of mupirocin reduce the risk of infections, 2,22 and CHG bathing alone specifically reduces the risk of central catheter-associated bloodstream infections in ICU patients 4,[23][24][25][26] and long-term acute care patients. 27 Two studies 24,28 demonstrated that CHG bathing reduced the rate of blood culture contamination.…”

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confidence: 99%

“…10 A review of the literature provides evidence that CHG bathing has several benefits. 4,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] CHG bathing reduces the acquisition of vancomycin-resistant Enterococcus by hospitalized ICU patients, 4,[10][11][12][13][14] Clostridium difficile, 15 and hospital-acquired MRSA. 4,[11][12][13]16,17 Bathing with CHG also reduces MRSA skin colonization in known MRSA carrier patients during their treatment.…”

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confidence: 99%

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Chlorhexidine Gluconate Bathing to Reduce Methicillin-Resistant Staphylococcus aureus Acquisition

Petlin

Schallom

Prentice

et al. 2014

Critical Care Nurse

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This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Discuss current research on chlorhexidine gluconate (CHG) bathing 2. Compare use of CHG-impregnated washcloths with CHG solution dissolved in bath water 3. Describe the effects of CHG bathing on methicillin-resistant Staphylococcus aureus BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism causing substantial morbidity and mortality in intensive care units. Chlorhexidine gluconate, a topical antiseptic solution, is effective against a wide spectrum of gram-positive and gram-negative bacteria, including MRSA. OBJECTIVES To examine the impact of a bathing protocol using chlorhexidine gluconate and bath basin management on MRSA acquisition in 5 adult intensive care units and to examine the cost differences between chlorhexidine bathing by using the bath-basin method versus using prepackaged chlorhexidineimpregnated washcloths. METHODS The protocol used a 4-oz bottle of 4% chlorhexidine gluconate soap in a bath basin of warm water. Patients in 3 intensive care units underwent active surveillance for MRSA acquisition; patients in 2 other units were monitored for a new positive culture for MRSA at any site 48 hours after admission. RESULTS Before the protocol, 132 patients acquired MRSA in 34 333 patient days (rate ratio, 3.84). Afterwards, 109 patients acquired MRSA in 41 376 patient days (rate ratio, 2.63). The rate ratio difference is 1.46 (95% CI, 1.12-1.90; P = .003). The chlorhexidine soap and bath basin method cost $3.18 as compared with $5.52 for chlorhexidine-impregnated wipes (74% higher). CONCLUSIONS The chlorhexidine bathing protocol is easy to implement, cost-effective, and led to decreased unit-acquired MRSA rates in a variety of adult intensive care units. (Critical Care Nurse. 2014;34[5] Reduction and elimination of hospital-acquired infections requires a multipronged approach. Hand hygiene is the primary strategy to reduce hospital-acquired infections and prevent transmission of resistant microbes between patients.5 Rapid reporting of culture results allows the health care team to initiate timely contact isolation precautions that help reduce the spread of infection once a resistant organism is identified. A multidisciplinary critical care team partnership with infection prevention specialists can facilitate these evidence-based prevention strategies. The increase in MRSA prevalence in the community and the high level of mortality associated with MRSA (3.62 deaths per 100000 population in the United States) 1 require clinicians to continuously explore measures to prevent MRSA acquisition in critically ill patients. MRSA colonization can be a source of fear, anxiety, and uncertainty for patients.6-8 Therefore, prevention of hospital-acquired MRSA is an important nursing intervention. Chlorhexidine gluconate (CHG), a topical antiseptic solution, is effective against a wide spectrum of grampositive and...

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Association Between Selective Decontamination of the Digestive Tract and In-Hospital Mortality in Intensive Care Unit Patients Receiving Mechanical Ventilation

Hammond

Myburgh

Seppelt

et al. 2022

JAMA

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ImportanceThe effectiveness of selective decontamination of the digestive tract (SDD) in critically ill adults receiving mechanical ventilation is uncertain.ObjectiveTo determine whether SDD is associated with reduced risk of death in adults receiving mechanical ventilation in intensive care units (ICUs) compared with standard care.Data SourcesThe primary search was conducted using MEDLINE, EMBASE, and CENTRAL databases until September 2022.Study SelectionRandomized clinical trials including adults receiving mechanical ventilation in the ICU comparing SDD vs standard care or placebo.Data Extraction and SynthesisData extraction and risk of bias assessments were performed in duplicate. The primary analysis was conducted using a bayesian framework.Main Outcomes and MeasuresThe primary outcome was hospital mortality. Subgroups included SDD with an intravenous agent compared with SDD without an intravenous agent. There were 8 secondary outcomes including the incidence of ventilator-associated pneumonia, ICU-acquired bacteremia, and the incidence of positive cultures of antimicrobial-resistant organisms.ResultsThere were 32 randomized clinical trials including 24 389 participants in the analysis. The median age of participants in the included studies was 54 years (IQR, 44-60), and the median proportion of female trial participants was 33% (IQR, 25%-38%). Data from 30 trials including 24 034 participants contributed to the primary outcome. The pooled estimated risk ratio (RR) for mortality for SDD compared with standard care was 0.91 (95% credible interval [CrI], 0.82-0.99; I2 = 33.9%; moderate certainty) with a 99.3% posterior probability that SDD reduced hospital mortality. The beneficial association of SDD was evident in trials with an intravenous agent (RR, 0.84 [95% CrI, 0.74-0.94]), but not in trials without an intravenous agent (RR, 1.01 [95% CrI, 0.91-1.11]) (P value for the interaction between subgroups = .02). SDD was associated with reduced risk of ventilator-associated pneumonia (RR, 0.44 [95% CrI, 0.36-0.54]) and ICU-acquired bacteremia (RR, 0.68 [95% CrI, 0.57-0.81]). Available data regarding the incidence of positive cultures of antimicrobial-resistant organisms were not amenable to pooling and were of very low certainty.Conclusions and RelevanceAmong adults in the ICU treated with mechanical ventilation, the use of SDD compared with standard care or placebo was associated with lower hospital mortality. Evidence regarding the effect of SDD on antimicrobial resistance was of very low certainty.

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Prevention of acquired infections in intubated patients with the combination of two decontamination regimens

Abstract: Acquired infections were substantially reduced by mupirocin/chlorhexidine plus polymyxin/tobramycin, whereas each regimen given alone was ineffective. Whether both regimens could increase Candida infections deserves further investigation.

Cited by 87 publications

References 33 publications

Lactoferrin: an iron-binding antimicrobial protein against Escherichia coli infection

Lactoferrin: an iron-binding antimicrobial protein against Escherichia coli infection

Chlorhexidine Gluconate Bathing to Reduce Methicillin-Resistant Staphylococcus aureus Acquisition

Association Between Selective Decontamination of the Digestive Tract and In-Hospital Mortality in Intensive Care Unit Patients Receiving Mechanical Ventilation

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