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Infection control measures to decrease the burden of antimicrobial resistance in the critical care setting

Landelle, Carolinea; Marimuthu, Kalisvara,b; Harbarth, Stephana

Current Opinion in Critical Care: October 2014 - Volume 20 - Issue 5 - p 499–506
doi: 10.1097/MCC.0000000000000126
INFECTIOUS DISEASES: Edited by Michael S. Niederman

Purpose of review: The prevalence of multidrug-resistant organisms (MDROs) in ICUs is increasing worldwide. This review assesses the role of infection control measures, excluding antibiotic stewardship programs, in reducing the burden of resistance in ICUs.

Recent findings: The knowledge base about the effect of increased hand hygiene compliance in reducing the burden of methicillin-resistant Staphylococcus aureus in ICUs has been improved. Universal decolonization with chlorhexidine body washing was associated with significant reduction in MDRO prevalence, but vigilance for emerging chlorhexidine resistance is required. A significant reduction of resistance for Gram-negative bacilli has been demonstrated with the use of selective decontamination, but further clinical trials are necessary before definitive conclusions can be drawn regarding long-term risk/benefit ratios.

Summary: In the recent years, several high-quality clinical studies have assessed the ability of various infection control measures in reducing the burden of antimicrobial resistance. Significant progress has been made in identifying interventions effective in preventing transmission of MDROs in ICUs, in particular, decolonization. However, it still remains impossible to determine the exact and relative importance of different infection control measures. Any approach must ultimately be tailored to the local epidemiology of the targeted ICU.

aInfection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

bInstitute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore

Correspondence to Stephan Harbarth, MD, MS, Infection Control Program, Geneva University Hospitals and Medical School, 1211 Geneva 14, Switzerland. Tel: +41 223723357; fax: +41 223723987; e-mail: stephan.harbarth@hcuge.ch

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins