Álvarez-Lerma F, Catalán-González M, Álvarez J, Sánchez-García M, Palomar-Martínez M, Fernández-Moreno I, Garnacho-Montero J, Barcenilla-Gaite F, García R, Aranaz-Andrés J, Lozano-García FJ, Ramírez-Galleymore P, Martínez-Alonso M. Impact of the "Zero Resistance" program on acquisition of multidrug-resistant bacteria in patients admitted to Intensive Care Units in Spain. A prospective, intervention, multimodal, multicenter study.
Med Intensiva 2023:S2173-5727(22)00349-6. [PMID:
36670011 DOI:
10.1016/j.medine.2022.12.002]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE
To assess the impact of a multimodal interventional project ("Zero Resistance") on the acquisition of multidrug-resistant bacteria (MDR-B) during the patient's ICU stay.
DESIGN
Prospective, open-label, interventional, multicenter study.
SETTING
103 ICUs.
PATIENTS
Critically ill patients admitted to the ICUs over a 27-month period.
INTERVENTIONS
Implementation of a bundle of 10 recommendations to prevent emergence and spread of MDR-B in the ICU.
MAIN VARIABLE OF INTEREST
Rate of patients acquiring MDR-B during their ICU stay, with differentiation between colonization and infection.
RESULTS
A total of 139,505 patients were included. In 5409 (3.9%) patients, 6020 MDR-B on ICU admission were identified, and in 3648 (2.6%) patients, 4269 new MDR-B during ICU stay were isolated. The rate of patients with MDR-B detected on admission increased significantly (IRR 1.43, 95% CI 1.31-1.56) (p<0.001) during the study period, with an increase of 32.2% between the initial and final monthly rates. On the contrary, the rate of patients with MDR-B during ICU stay decreased non-significantly (IRR 0.93, 95% CI 0.83-1.03) (p=0.174), with a 24.9% decrease between initial and final monthly rates. According to the classification into colonization or infection, there was a highly significant increase of MDR-B colonizations detected on admission (IRR 1.69, 95% CI 1.52-1.83; p<0.0001) and a very significant decrease of MDR-B-infections during ICU stay (IRR 0.67, 95% CI 0.57-0.80, p<0.0001).
CONCLUSIONS
The implementation of ZR project-recommendations was associated with a significantly reduction an infection produced by MDR-B acquired during the patient's ICU stay.
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