Skip to main content

Advertisement

SpringerLink
Log in

Prevention of ICU-acquired infection with decontamination regimen in immunocompromised patients: a pre/post observational study

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose

Although the proportion of immunocompromised patients admitted to the ICU is increasing, data regarding specific management, including acquired infection (ICU-AI) prophylaxis, in this setting are lacking. We aim to investigate the effect of multiple-site decontamination regimens (MSD) in immunocompromised patients.

Methods

We conducted a prospective pre-/post-observational study in 2 ICUs in Bretagne, western France. Adults who required mechanical ventilation for 24 h or more were eligible. During the study period, MSD was implemented in participating ICUs in addition to standard care. It consists of the administration of topical antibiotics (gentamicin, colistin sulfate, and amphotericin B), four times daily in the oropharynx and the gastric tube, 4% chlorhexidine bodywash once daily, and a 5-day nasal mupirocin course.

Results

Overall, 295 immunocompromised patients were available for analysis (151 in the post-implementation group vs 143 in the pre-implementation group). Solid organ cancer was present in 77/295 patients while immunomodulatory treatments were noticed in 135/295. They were 35 ICU-AI in 29/143 patients in the standard-care group as compared with 10 ICU-AI in 9/151 patients in the post-implementation group (p < 0.001). In a multivariable Poisson regression model, MSD was independently associated with a decreased incidence of ICU-AI (incidence rate ratio = 0.39; 95%CI [0.20–0.87] p = 0.008). There were 35/143 deaths in the standard-care group as compared with 22/151 in the post-implementation group (p = 0.046), this difference remained in a multivariable Cox model (HR = 0.58; 95CI [0.34–0.95] p = 0.048).

Conclusion

In conclusion, MSD appeared to be associated with improved outcomes in critically ill immunocompromised patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets generated during the current study are available from the corresponding author upon reasonable request.

References

  1. van Vliet M, Verburg IWM, van den Boogaard M et al (2014) Trends in admission prevalence, illness severity and survival of haematological patients treated in Dutch intensive care units. Intensive Care Med 40:1275–1284. https://doi.org/10.1007/s00134-014-3373-x

    Article  PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30. https://doi.org/10.3322/caac.21442

    Article  PubMed  Google Scholar 

  3. Mokart D, Pastores SM, Darmon M (2014) Has survival increased in cancer patients admitted to the ICU? Yes. Intensive Care Med 40:1570–1572. https://doi.org/10.1007/s00134-014-3433-2

    Article  PubMed  Google Scholar 

  4. Moreau AS, Martin-Loeches I, Povoa P, Salluh J, Rodriguez A, Thille AW, Diaz Santos E, Vedes E, Lobo SM, Mégarbane B, MoleroSilvero E, Coelho L, Argaud L, Sanchez Iniesta R, Labreuche J, Rouzé A, Nseir S, TAVeM Study Group (2018) Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections. Eur Respir J 51(3):1701656. https://doi.org/10.1183/13993003.01656-2017

    Article  CAS  PubMed  Google Scholar 

  5. Massart N, Reizine F, Fillatre P, Seguin P, La Combe B, Frerou A, Egreteau PY, Hourmant B, Kergoat P, Lorber J, Souchard J, Canet E, Rieul G, Fedun Y, Delbove A, Camus C (2022) Multiple-site decontamination regimen decreases acquired infection incidence in mechanically ventilated COVID-19 patients. Ann Intensive Care 12(1):84. https://doi.org/10.1186/s13613-022-01057-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Camus C, Bellissant E, Sebille V et al (2005) Prevention of acquired infections in intubated patients with the combination of two decontamination regimens. Crit Care Med 33(2):307–314. https://doi.org/10.1097/01.ccm.0000152224.01949.01

    Article  PubMed  Google Scholar 

  7. de Jong PJ, de Jong MD, Kuijper EJ, van der Lelie H (1993) The value of surveillance cultures in neutropenic patients receiving selective intestinal decontamination. Scand J Infect Dis 25(1):107–113

    Article  PubMed  Google Scholar 

  8. E.O.R.T.C. (1982) Gnotobiotic Project Group: a prospective cooperative study of antimicrobial decontamination in granulocytopenic patients. Comparison of two different methods. Infection 10(3):131–8. https://doi.org/10.1007/BF01640762

    Article  Google Scholar 

  9. Bow EJ, Rayner E, Scott BA, Louie TJ (1987) Selective gut decontamination with nalidixic acid or trimethoprim-sulfamethoxazole for infection prophylaxis in neutropenic cancer patients: relationship of efficacy to antimicrobial spectrum and timing of administration. Antimicrob Agents Chemother 31(4):551–557. https://doi.org/10.1128/AAC.31.4.551

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Schauwvlieghe AFAD, Rijnders BJA, Philips N, Verwijs R, Vanderbeke L, Van Tienen C, Lagrou K, Verweij PE, Van de Veerdonk FL, Gommers D, Spronk P, Bergmans DCJJ, Hoedemaekers A, Andrinopoulou ER, van den Berg CHSB, Juffermans NP, Hodiamont CJ, Vonk AG, Depuydt P, Boelens J, Wauters J, Dutch-Belgian Mycosis study group (2018) Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med 6(10):782–792. https://doi.org/10.1016/S2213-2600(18)30274-1

    Article  PubMed  Google Scholar 

  11. Massart N, Dupin C, Legris E, Fedun Y, Barbarot N, Legay F, Wattecamps G, Le Gall F, La Combe B, Bouju P, Frerou A, Muller L, Rieul G, Fillatre P (2023) Multiple-site decontamination in mechanically ventilated ICU patients: A real-life study. Infect Dis Now 53(3):104666. https://doi.org/10.1016/j.idnow.2023.104666

    Article  PubMed  Google Scholar 

  12. Massart N, Dupin C, Mari A et al (2021) Clinician involvement for ventilator-associated pneumonia surveillance resulted in higher than expected incidence rate reported with implication for attributable mortality. Infect Dis (Lond) 53(2):154–157. https://doi.org/10.1080/23744235.2020.1839129

    Article  PubMed  Google Scholar 

  13. Blot SI, Taccone FS, Van den Abeele AM, Bulpa P et al (2012) A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med 186(1):56–64. https://doi.org/10.1164/rccm.201111-1978OC. (Erratum in: Am J Respir Crit Care Med. 2012 Oct 15;186(8):808)

    Article  PubMed  Google Scholar 

  14. Verweij PE, Rijnders BJA, Brüggemann RJM et al (2020) Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion. Intensive Care Med 46(8):1524–1535. https://doi.org/10.1007/s00134-020-06091-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Koehler P, Bassetti M, Chakrabarti A et al (2021) Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis 21(6):e149–e162. https://doi.org/10.1016/S1473-3099(20)30847-1

    Article  CAS  PubMed  Google Scholar 

  16. Massart N, Camus C, Benezit F, Moriconi M, Fillatre P, Le Tulzo Y (2020) Incidence and risk factors for acquired colonization and infection due to extended-spectrum beta-lactamase-producing Gram-negative bacilli: a retrospective analysis in three ICUs with low multidrug resistance rate. Eur J Clin Microbiol Infect Dis 39(5):889–895. https://doi.org/10.1007/s10096-019-03800-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Kreitmann L, Vasseur M, Jermoumi S, Perche J, Richard JC, Wallet F, Chabani M, Nourry E, Garçon P, Zerbib Y, Van Grunderbeeck N, Vinsonneau C, Preda C, Labreuche J, Nseir S (2023) Relationship between immunosuppression and intensive care unit-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter cohort study. Intensive Care Med 49(2):154–165. https://doi.org/10.1007/s00134-022-06954-0

    Article  CAS  PubMed  Google Scholar 

  18. Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Bruzzi de Carvalho F et al (2012) Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 38(12):1930–1945

    Article  PubMed  Google Scholar 

  19. Leone M, Bouadma L, Bouhemad B et al (2018) Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain Med 37(1):83–98. https://doi.org/10.1016/j.accpm.2017.11.006

    Article  PubMed  Google Scholar 

  20. Magiorakos AP, Srinivasan A, Carey RB et al (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18(3):268–281. https://doi.org/10.1111/j.1469-0691.2011.03570.x

    Article  CAS  PubMed  Google Scholar 

  21. Harpaz R, Dahl RM, Dooling KL (2016) Prevalence of Immunosuppression Among US Adults, 2013. JAMA 316(23):2547–2548. https://doi.org/10.1001/jama.2016.16477

    Article  PubMed  Google Scholar 

  22. Azoulay É, Castro P, Maamar A, Metaxa V, de Moraes AG, Voigt L, Wallet F, Klouche K, Picard M, Moreau AS, Van De Louw A, Seguin A, Mokart D, Chawla S, Leroy J, Böll B, Issa N, Levy B, Hemelaar P, Fernandez S, Munshi L, Bauer P, Schellongowski P, Joannidis M, Moreno-Gonzalez G, Galstian G, Darmon M, Valade S, Nine-I investigators (2021) Outcomes in patients treated with chimeric antigen receptor T-cell therapy who were admitted to intensive care (CARTTAS): an international, multicentre, observational cohort study. Lancet Haematol 8(5):e355–e364. https://doi.org/10.1016/S2352-3026(21)00060-0

    Article  CAS  PubMed  Google Scholar 

  23. Toffart AC, Meert AP, Wallet F, Gibelin A, Guisset O, Gonzalez F, Seguin A, Kouatchet A, Delaunay M, Debieuvre D, Duchemann B, Rousseau-Bussac G, Nyunga M, Grimaldi D, Levrat A, Azoulay E, Lemiale V (2023) ICU admission for solid cancer patients treated with immune checkpoint inhibitors. Ann Intensive Care 13(1):29. https://doi.org/10.1186/s13613-023-01122-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Timsit JF, Sonneville R, Kalil AC, Bassetti M, Ferrer R, Jaber S, Lanternier F, Luyt CE, Machado F, Mikulska M, Papazian L, Pène F, Poulakou G, Viscoli C, Wolff M, Zafrani L, Van Delden C (2019) Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients. Intensive Care Med 45(5):573–591. https://doi.org/10.1007/s00134-019-05597-y

    Article  PubMed  PubMed Central  Google Scholar 

  25. Florescu DF, Sandkovsky U, Kalil AC (2017) Sepsis and Challenging Infections in the Immunosuppressed Patient in the Intensive Care Unit. Infect Dis Clin North Am 31(3):415–434. https://doi.org/10.1016/j.idc.2017.05.009

    Article  PubMed  Google Scholar 

  26. de Smet AM, Kluytmans JA, Cooper BS et al (2009) Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 360(1):20–31. https://doi.org/10.1056/NEJMoa0800394

    Article  PubMed  Google Scholar 

  27. Roquilly A, Chanques G, Lasocki S, Foucrier A, Fermier B, De Courson H, Carrie C, Danguy des Deserts M, Gakuba C, Constantin JM, Lagarde K, Holleville M, Blidi S, Sossou A, Cailliez P, Monard C, Oudotte A, Mathieu C, Bourenne J, Isetta C, Perrigault PF, Lakhal K, Rouhani A, Asehnoune K, Guerci P, Tran Dinh A, Chousterman B, Cupaciu A, Dahyot-Fizelier C, Bellier R, Au Duong J, Mansour A, Morel J, Beauplet G, Vibet MA, Feuillet F, Sébille V, Leone M (2021) Implementation of French recommendations for the prevention and the treatment of hospital-acquired pneumonia: a cluster-randomized trial. Clin Infect Dis. 73(7):e1601-e1610. https://doi.org/10.1093/cid/ciaa1441

  28. Camus C, Sauvadet E, Tavenard A et al (2016) Decline of multidrug-resistant Gram negative infections with the routine use of a multiple decontamination regimen in ICU. J Infect 73(3):200–209. https://doi.org/10.1016/j.jinf.2016.06.007

    Article  PubMed  Google Scholar 

  29. de Jonge E, Schultz MJ, Spanjaard L, Bossuyt PM, Vroom MB, Dankert J, Kesecioglu J (2003) Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 362(9389):1011–1016. https://doi.org/10.1016/S0140-6736(03)14409-1

    Article  CAS  PubMed  Google Scholar 

  30. Azoulay E, Russell L, Van de Louw A, Metaxa V, Bauer P, Povoa P, Montero JG, Loeches IM, Mehta S, Puxty K, Schellongowski P, Rello J, Mokart D, Lemiale V, Mirouse A, Nine-i Investigators (2020) Diagnosis of severe respiratory infections in immunocompromised patients. Intensive Care Med 46(2):298–314. https://doi.org/10.1007/s00134-019-05906-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Gangneux JP, Dannaoui E, Fekkar A, Luyt CE, Botterel F, De Prost N, Tadié JM, Reizine F, Houzé S, Timsit JF, Iriart X, Riu-Poulenc B, Sendid B, Nseir S, Persat F, Wallet F, Le Pape P, Canet E, Novara A, Manai M, Cateau E, Thille AW, Brun S, Cohen Y, Alanio A, Mégarbane B, Cornet M, Terzi N, Lamhaut L, Sabourin E, Desoubeaux G, Ehrmann S, Hennequin C, Voiriot G, Nevez G, Aubron C, Letscher-Bru V, Meziani F, Blaize M, Mayaux J, Monsel A, Boquel F, Robert-Gangneux F, Le Tulzo Y, Seguin P, Guegan H, Autier B, Lesouhaitier M, Pelletier R, Belaz S, Bonnal C, Berry A, Leroy J, François N, Richard JC, Paulus S, Argaud L, Dupont D, Menotti J, Morio F, Soulié M, Schwebel C, Garnaud C, Guitard J, Le Gal S, Quinio D, Morcet J, Laviolle B, Zahar JR, Bougnoux ME (2022) Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study. Lancet Respir Med 10(2):180–190. https://doi.org/10.1016/S2213-2600(21)00442-2

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The Authors thank Florence MASSART and Brendan STOY for their help in the English writing of the article.

Author information

Authors and Affiliations

  1. Service de Réanimation, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France

    Nicolas Massart, François Legay & Pierre Fillatre

  2. Service de Microbiologie, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France

    Clarisse Dupin

  3. Service de Pharmacie, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France

    Eleonore Legris

  4. Service de Microbiologie, CH de Vannes, 20 bvd général maurice guillaudot, 56000, Vannes, France

    Anne Cady

  5. Service de Réanimation, CH de Vannes, 20, Bd Maurice Guillaudot, 56000, Vannes, France

    Florian Reizine

Authors
  1. Nicolas Massart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clarisse Dupin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eleonore Legris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. François Legay
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne Cady
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pierre Fillatre
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Florian Reizine
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors participated in the acquisition of data. NM, FR, and PF participated in the conception and design of the study, and NM performed the analysis and interpretation of data. NM and FR drafted the article, and all authors finally approved the submitted version.

Corresponding author

Correspondence to Nicolas Massart.

Ethics declarations

Ethics approval

The study protocol received approval from the Rennes Hospital ethics committee (comité d’éthique du CHU de Rennes avis 19–52).

Consent to participate

Patients or closest relatives were informed of the anonymous prospective collection of the data and had the possibility not to participate in the study. In case of refusal, the data were not collected accordingly.

Competing interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 431 KB)

Supplementary file2 (DOCX 23 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Massart, N., Dupin, C., Legris, E. et al. Prevention of ICU-acquired infection with decontamination regimen in immunocompromised patients: a pre/post observational study. Eur J Clin Microbiol Infect Dis 42, 1163–1172 (2023). https://doi.org/10.1007/s10096-023-04650-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-023-04650-5

Keywords

Search

Navigation