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Original article
Available online 19 January 2023
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
Impacto del Proyecto “Resistencia Zero” en la adquisición de bacterias multirresistentes en pacientes ingresados en Unidades de Cuidados Intensivos en España. Estudio de intervención, multimodal y multicéntrico
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Francisco Álvarez-Lermaa,
Corresponding author
falvarez@psmar.cat

Corresponding author.
, Mercedes Catalán-Gonzálezb, Joaquín Álvarezc, Miguel Sánchez-Garcíad, Mercedes Palomar-Martíneze, Inmaculada Fernández-Morenof, José Garnacho-Monterog, Fernando Barcenilla-Gaiteh, Rosa Garcíai, Jesús Aranaz-Andrésj, Francisco J. Lozano-Garcíak, Paula Ramírez-Galleymorel, Montserrat Martínez-Alonsom
a Service of Intensive Care Medicine, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
b Service of Intensive Care Medicine, Hospital 12 de Octubre, Madrid, Spain
c Service of Intensive Care Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
d Service of Intensive Care Medicine, Hospital Clínico San Carlos, Madrid, Spain
e SEMICYUC Working Group on Infections Diseases, Madrid, Spain
f Intensive Care Unit, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
g Service of Intensive Care Medicine, Hospital Universitario Virgen Macarena, Sevilla, Spain
h Service of Intensive Care Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain
i Service of Anesthesia and Resuscitation, Hospital Universitario de Basurto, Bilbao, Spain
j Service of Preventive Medicine and Public Health, Hospital Universitario Ramón y Cajal, Madrid, Spain
k Service of Preventive Medicine, Hospital General Universitario de Burgos, Burgos, Spain
l Service of Intensive Care Medicine, Hospital Universitario i Politècnico La Fe, Valencia, Spain
m Department of Basic Sciences, Unit of Biostatistics, Institut de Reserca Biomèdica de Lleida-Universitat de Lleida, Lleida, Spain
Received 28 September 2022. Accepted 12 December 2022
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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.

Keywords:
Critical ill patient
ICU
Multidrug-resistant bacteria
Surveillance studies
Preventive isolation
Antimicrobial use
Elimination of reservoirs
“Zero Resistance Project”
Resumen
Objetivo

Evaluar el impacto de un proyecto de intervención multimodal (“Resistencia Zero”, RZ) en la adquisición de bacterias multirresistentes (BMR) durante la estancia en UCI.

Diseño

Estudio prospectivo, abierto, intervencionista, multicéntrico.

Ámbito

103 UCI.

Pacientes

Pacientes críticos ingresados en UCI, durante un período de 27 meses.

Intervenciones

Implementación de un paquete de 10 recomendaciones para prevenir la aparición y propagación de BMR en UCI.

Principal variable de interés

Tasa de pacientes que adquieren BMR durante su estancia en UCI, diferenciando entre colonización e infección.

Resultados

Se incluyeron 139.505 pacientes. En 5.409(3,9%), se identificaron 6.020 BMR al ingreso y en 3.648(2,6%), se aislaron 4.269 nuevas BMR durante la estancia en UCI. La tasa de pacientes con BMR detectadas al ingreso aumentó significativamente (IRR 1,43, IC 95% 1,31–1,56) (p<0,001) durante el periodo de estudio, con un incremento del 32,2% entre las tasas mensuales inicial y final. Por el contrario, la tasa de pacientes con BMR detectadas durante la estancia en UCI disminuyó, no significativamente (IRR 0,93, IC 95% 0,83–1,03) (p=0,174), con una disminución del 24,9% entre las tasas mensuales iniciales y finales. Según la clasificación en colonización o infección, hubo un aumento significativo de colonizaciones por BMR detectadas al ingreso (IR 1,69, IC 95% 1,52–1,83; p<0,0001) y una disminución significativa de infecciones producidas por BMR adquiridas durante la estancia en UCI (IR 0,67, IC 95% 0,57–0,80, p<0,0001).

Conclusiones

La implementación de las recomendaciones del proyecto RZ se asoció con una reducción significativa de pacientes con infecciones por BMR adquiridas en UCI.

Palabras clave:
Paciente crítico
ICU
BMR
Estudios de vigilancia
Aislamiento preventivo
Uso antimicrobianos
Eliminación de reservorios
“Proyecto Resistencia Zero”

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