Combatting resistance in intensive care: the multimodal approach of the Spanish ICU “Zero Resistance” program

Garnacho-Montero, José; Lerma, F. Álvarez; Ramírez, Paula; Martínez, Mercedes Palomar; Rocha, L. Álvarez; Gaite, F. Barcenilla; Álvarez-Rodríguez, Joaquín; González, Mercedes Catalán; Moreno, Inmaculada Fernández; Rodríguez-Baño, Jesús; Campos, José; Andrés, Jesús Ma Aranaz; Varela, Yolanda Agra; Gay, Carolina Rodríguez; García, Miguel Sánchez

doi:10.1186/s13054-015-0800-5

Cited by 62 publications

(23 citation statements)

References 48 publications

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“…These data raise concern about a potential role of contamination as a reservoir for resistant species, their selection and subsequent development of ICU-acquired colonization and infections. For these reasons, the issue of environmental contamination has been included in a recently published bundle of recommendations aiming to reduce the incidence of ICU-acquired infections caused by MDR pathogens [ 17 ]. However, further studies are needed to elucidate the contribution of inanimate surfaces and equipment contamination to relevant patient outcomes (e.g., mortality, ICU length of stay).…”

Section: Reviewmentioning

confidence: 99%

“…Factors that may affect the transfer of microorganisms from one surface to another and cross-contamination rates are type of organisms, source and destination surfaces, humidity level, and size of inoculum [ 15 , 16 ]. However, other factors playing a role in contamination and cross-transmission rate in the ICU may include hand hygiene compliance, nurse-staffing levels, frequency/number of colonized or infected patients, ICU structural features (e.g., single-bed or multi-bed ICU rooms) and adoption of antibiotic stewardship programs [ 17 , 18 ]. The issue of environmental contamination may pose an even greater challenge in the ICU, where patients are critically ill, with several risk factors for nosocomial infections [ 19 ], and the highest standard measures for infection prevention cannot always be addressed due to impelling, life-threatening conditions.…”

Section: Introductionmentioning

confidence: 99%

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Bacterial contamination of inanimate surfaces and equipment in the intensive care unit

2015

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Intensive care unit (ICU)-acquired infections are a challenging health problem worldwide, especially when caused by multidrug-resistant (MDR) pathogens. In ICUs, inanimate surfaces and equipment (e.g., bedrails, stethoscopes, medical charts, ultrasound machine) may be contaminated by bacteria, including MDR isolates. Cross-transmission of microorganisms from inanimate surfaces may have a significant role for ICU-acquired colonization and infections. Contamination may result from healthcare workers’ hands or by direct patient shedding of bacteria which are able to survive up to several months on dry surfaces. A higher environmental contamination has been reported around infected patients than around patients who are only colonized and, in this last group, a correlation has been observed between frequency of environmental contamination and culture-positive body sites. Healthcare workers not only contaminate their hands after direct patient contact but also after touching inanimate surfaces and equipment in the patient zone (the patient and his/her immediate surroundings). Inadequate hand hygiene before and after entering a patient zone may result in cross-transmission of pathogens and patient colonization or infection. A number of equipment items and commonly used objects in ICU carry bacteria which, in most cases, show the same antibiotic susceptibility profiles of those isolated from patients. The aim of this review is to provide an updated evidence about contamination of inanimate surfaces and equipment in ICU in light of the concept of patient zone and the possible implications for bacterial pathogen cross-transmission to critically ill patients.

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Section: Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bacterial contamination of inanimate surfaces and equipment in the intensive care unit

2015

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“…The main objective of the “Zero Resistance” project is reduction in the cumulative incidence of patients with ICU-acquired MDR infections by 20 % with a bundle of 10 recommendations. The primary aim of the antibiotic program is to supervise the three most influential contributing factors to the development and transmission of MDROs, namely: (1) adequate prescription of antibiotics; (2) early detection and prevention of cross-colonization of MDR; and (3) elimination of reservoirs [ 43 ]. Results of this ambitious project will shed light on AMS programs in the near future.…”

Section: Antibiotic Stewardship (Ams) and Infection Control Strategiementioning

confidence: 99%

What’s new in multidrug-resistant pathogens in the ICU?

Zilahi

Artigas

Martín‐Loeches

2016

Ann. Intensive Care

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Over the last several decades, antibacterial drug use has become widespread with their misuse being an ever-increasing phenomenon. Consequently, antibacterial drugs have become less effective or even ineffective, resulting in a global health security emergency. The prevalence of multidrug-resistant organisms (MDROs) varies widely among regions and countries. The primary aim of antibiotic stewardship programs is to supervise the three most influential factors contributing to the development and transmission of MDROs, namely: (1) appropriate antibiotic prescribing; (2) early detection and prevention of cross-colonization of MDROs; and (3) elimination of reservoirs. In the future, it is expected that a number of countries will experience a rise in MDROs. These infections will be associated with a high consumption of healthcare resources manifested by a prolonged hospital stay and high mortality. As a counteractive strategy, minimization of broad-spectrum antibiotic use and prompt antibiotic administration will aid in reduction of antibiotic resistance. Innovative management approaches include development and implementation of rapid diagnostic tests that will help in both shortening the duration of therapy and allowing early targeted therapy. The institution of more accessible therapeutic drug monitoring will help to optimize drug administration and support a patient-specific approach. Areas where further research is required are investigation into the heterogeneity of critically ill patients and the need for new antibacterial drug development.

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“… 18 Rapid detection of resistant bacteria and their genetic characterization through molecular techniques is therefore a pivotal component of surveillance and control of diffusion of resistant bacteria from a single institution to a global level. 19 , 20 …”

Section: Epidemiology Of Bsis Caused By Resistant Bacteriamentioning

confidence: 99%

“… 29 Knowledge of risk factors for BSIs caused by resistant bacteria may have a major influence on global management in ICUs, from source-control and surveillance measures to appropriate antibiotic treatment. 19 …”

Section: Risk Factors For Bsi Caused By Resistant Bacteriamentioning

confidence: 99%

Bloodstream infections in intensive care unit patients: distribution and antibiotic resistance of bacteria

Russotto

Cortegiani

Graziano

et al. 2015

IDR

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Bloodstream infections (BSIs) are among the leading infections in critically ill patients. The case-fatality rate associated with BSIs in patients admitted to intensive care units (ICUs) reaches 35%–50%. The emergence and diffusion of bacteria with resistance to antibiotics is a global health problem. Multidrug-resistant bacteria were detected in 50.7% of patients with BSIs in a recently published international observational study, with methicillin resistance detected in 48% of Staphylococcus aureus strains, carbapenem resistance detected in 69% of Acinetobacter spp., in 38% of Klebsiella pneumoniae, and in 37% of Pseudomonas spp. Prior hospitalization and antibiotic exposure have been identified as risk factors for infections caused by resistant bacteria in different studies. Patients with BSIs caused by resistant strains showed an increased risk of mortality, which may be explained by a higher incidence of inappropriate empirical therapy in different studies. The molecular genetic characterization of resistant bacteria allows the understanding of the most common mechanisms underlying their resistance and the adoption of surveillance measures. Knowledge of epidemiology, risk factors, mechanisms of resistance, and outcomes of BSIs caused by resistant bacteria may have a major influence on global management of ICU patients. The aim of this review is to provide the clinician an update on BSIs caused by resistant bacteria in ICU patients.

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Combatting resistance in intensive care: the multimodal approach of the Spanish ICU “Zero Resistance” program

Cited by 62 publications

References 48 publications

Bacterial contamination of inanimate surfaces and equipment in the intensive care unit

Bacterial contamination of inanimate surfaces and equipment in the intensive care unit

What’s new in multidrug-resistant pathogens in the ICU?

Bloodstream infections in intensive care unit patients: distribution and antibiotic resistance of bacteria

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