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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*

Camus, Christophe MD1,2; Salomon, Sylvain MD1; Bouchigny, Claire MSc2; Gacouin, Arnaud MD1; Lavoué, Sylvain MD1; Donnio, Pierre-Yves PharmD, PhD3; Javaudin, Loic PharmD4; Chapplain, Jean-Marc MD3; Uhel, Fabrice MD1; Le Tulzo, Yves MD, PhD1,2; Bellissant, Eric MD, PhD2,5

doi: 10.1097/CCM.0000000000000140
Clinical Investigations

Objectives: 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.

Design: 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.

Setting: Polyvalent medical ICU at a university-affiliated hospital.

Patients: All patients admitted to the ICU.

Interventions: 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.

Measurements and Main 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.

Supplemental Digital Content is available in the text.

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.

* See also p. 1296.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: christophe.camus@chu-rennes.fr

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins