title: Short-term decline in all-cause acquired infections with the routine use of a decontamination regimen combining topical polymyxin, tobramycin, and amphotericin B with mupirocin and chlorhexidine in the ICU: a single-center experience.
abstract: OBJECTIVE
  In a multicenter, placebo-controlled, randomized, double-blind trial, we showed that acquired infections in intubated patients were reduced by the combination of topical polymyxin plus tobramycin and nasal mupirocin plus chlorhexidine body wash. Because intubated patients are particularly at risk for acquired infections, we reassessed the impact of this protocol as a routine procedure to control acquired infections in the ICU.
  
  
  METHODS
  Nonrandomized study comparing acquired infections in ICU patients during two 1-year periods: the last year before (group A, n = 925) and the first year after the implementation of the protocol (group B, n = 1,022). Acquired infections were prospectively recorded.
  
  
  METHODS
  Polyvalent medical ICU at a university-affiliated hospital.
  
  
  METHODS
  All patients admitted to the ICU.
  
  
  METHODS
  Administration of polymyxin/tobramycin/amphotericin B in the oropharynx and the gastric tube plus a mupirocin/chlorhexidine regimen in intubated patients and standard care in the other patients.
  
  
  RESULTS
  The comparison of acquired infection rates between groups was adjusted for differences at baseline. Infection rates were lower in group B compared with group A (5.3% vs 11.0%; p < 0.001), as were the incidence rates of total acquired infections (9.4 vs 23.6 per 1,000 patient-days; p < 0.001), intubation-related pneumonia (5.1 vs 17.1 per 1,000 ventilator-days; p < 0.001), and catheter-related bloodstream infections (1.0 vs 3.5 per 1,000 catheter-days; p = 0.03). There were fewer acquired infections caused by ceftazidime-resistant Enterobacteriaceae (0.8‰ vs 3.6‰; p < 0.001), ciprofloxacin-resistant Enterobacteriaceae (0.8‰ vs 2.5‰; p = 0.02), ciprofloxacin-resistant Pseudomonas aeruginosa (0.5‰ vs 1.6‰; p = 0.05), and colistin-resistant Gram-negative bacilli (0.7‰ vs 1.9‰; p = 0.04). Fewer patients got acquired infections due to multidrug-resistant aerobic Gram-negative bacilli (p = 0.008).
  
  
  CONCLUSIONS
  In intubated patients, the use of topical polymyxin/tobramycin/amphotericin B plus mupirocin/chlorhexidine was associated with the reduction of all-cause ICU-acquired infections. Long-term emergence of multidrug-resistant organisms deserves further investigation.
authors.affiliation: 1Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France. 2Centre d'Investigation Clinique CIC-P INSERM 0203, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France. 3Laboratoire de Bactériologie, Virologie et Hygiène Hospitalière, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France. 4Pôle Pharmacie Hospitalière, Hôpital de Pontchaillou, CHU de Rennes, Rennes, France. 5Service de Pharmacologie, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Camus
authors.forename: Sylvain
authors.initials: S
authors.lastname: Salomon
authors.forename: Claire
authors.initials: C
authors.lastname: Bouchigny
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gacouin
authors.forename: Sylvain
authors.initials: S
authors.lastname: Lavoué
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Donnio
authors.forename: Loic
authors.initials: L
authors.lastname: Javaudin
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chapplain
authors.forename: Fabrice
authors.initials: F
authors.lastname: Uhel
authors.forename: Yves
authors.initials: Y
authors.lastname: Le Tulzo
authors.forename: Eric
authors.initials: E
authors.lastname: Bellissant
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002710:Chlorhexidine / Q000008:administration & dosage; D002985:Clinical Protocols; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004338:Drug Combinations; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units / Q000458:organization & administration*; D007440:Intubation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage; D011113:Polymyxins / Q000008:administration & dosage; D011446:Prospective Studies; D014031:Tobramycin / Q000008:administration & dosage
chemical_list: D000890:Anti-Infective Agents; D004338:Drug Combinations; D011113:Polymyxins; D000666:Amphotericin B; D016712:Mupirocin; D002710:Chlorhexidine; D014031:Tobramycin