title: Decline of multidrug-resistant Gram negative infections with the routine use of a multiple decontamination regimen in ICU.
abstract: We have shown that the routine use of a multiple decontamination regimen with oropharyngeal and digestive polymyxin/tobramycin/amphotericin B plus mupirocin/chlorhexidine in intubated patients reduced all-cause acquired infections (AIs) in the intensive care unit (ICU). We now assessed the long-term impact of this strategy on AIs involving multidrug-resistant aerobic Gram negative bacilli (AGNB) and acquired episodes of extended-spectrum betalactamase (ESBL)-producing Enterobacteriaceae rectal carriage.
  
  
  
  This was an observational single center study of all patients admitted to an ICU over 5 years (study population). Decontamination was given for the period of intubation and standard care otherwise. AIs and colonization rates were prospectively recorded. AIs rates were compared between the study period and a 1-year pre-intervention period. During study, trends were analyzed by semester using a Poisson regression model.
  
  
  
  The incidence rate of multidrug-resistant AGNB AIs was lower during the study (1.59 per 1000 patient-days, versus pre-intervention: 5.43‰, p < 0.001) and declined with time (adjusted OR = 0.85, 95 percent confidence interval 0.77-0.93, p < 0.001). ESBL-producing Enterobacteriaceae acquired colonization episodes (OR = 0.94 [0.88-1.00] P = 0.04) and the use of five major antibiotics (p < 0.001) also declined.
  
  
  
  A multiple decontamination regimen did not favor the emergence of multidrug-resistant AGNB. In contrast, infection and colonization rates declined with time.
authors.affiliation: Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France; Centre d'Investigation Clinique CIC INSERM 1414, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France. Electronic address: christophe.camus@chu-rennes.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Camus
authors.affiliation: Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Sauvadet
authors.affiliation: Centre d'Investigation Clinique CIC INSERM 1414, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Tavenard
authors.affiliation: Service de Bactériologie et Hygiène Hospitalière, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Piau
authors.affiliation: Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France; Centre d'Investigation Clinique CIC INSERM 1414, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Uhel
authors.affiliation: Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouju
authors.affiliation: Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Letheulle
authors.affiliation: Pôle Pharmacie Hospitalière, Hôpital de Pontchaillou, CHU de Rennes, Rennes, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dollo
authors.affiliation: Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France; Centre d'Investigation Clinique CIC INSERM 1414, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gacouin
authors.affiliation: Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Lavoué
authors.affiliation: Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France; Centre d'Investigation Clinique CIC INSERM 1414, Hôpital de Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Le Tulzo
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine; D003428:Cross Infection; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
keywords: Chlorhexidine; Intensive care unit; Multidrug-resistant Gram negative bacilli; Mupirocin; Selective digestive decontamination; Topical antibiotics