Interventions to prevent the acquisition of resistant Gram-negative bacteria in critically ill patients- A systematic review and meta-analysis
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Background: The rising incidence of multidrug-resistant Gram negative bacterial infections acquired in intensive care units has prompted a variety of patient-level infection control efforts. However, there is yet no consensus on which measures are effective. Design: Meta-analysis of studies to assess the efficacy of interventions in the prevention of colonization and infection with resistant Gram-negative bacteria in intensive care units. Methods: PubMed, Cochrane, Embase and World of Science databases were searched. Interventional comparative studies were systematically analyzed. Results: Comprehensive review of interventions with measureable outcomes resulted in 6 studies from a total of 631potential studies meeting all inclusion criteria. 5 randomized and 1 observational interventional trial evaluating 6 patient- level interventions were quantitatively analyzed. 2 randomized studies lacked data on infection. Compared to control settings, the use of probiotics and selective digestive decontamination were associated with a significant reduction of colonization with multidrug-resistant Gram negative bacteria (OR 0.39; 95%CI 0.16-0.95 and OR 0.54; 95%CI 0.38-0.77, respectively). No significant reduction in infection was observed by any patient-level intervention (pooled OR 1.24, 95% CI 0.94-1.64). Selective digestive decontamination was significantly associated with a reduction in intensive care unit mortality (OR 0.71; 95%CI 0.53-0.94). Conclusions: Several interventions appear to be promising in reducing colonization but despite lower colonization rates associated with these efforts they did not translate to a reduction in hospital-acquired infections. Colonization may not be the only predecessor of infection in intensive care units. The use of probiotics and selective decontamination of the digestive tract should be studied in large randomized controlled trials.
- Health services