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

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: Aislamiento preventivo; Antimicrobial use; BMR; Critical ill patient; Eliminación de reservorios; Elimination of reservoirs; Estudios de vigilancia; ICU; Multidrug-resistant bacteria; Paciente crítico; Preventive isolation; Surveillance studies; Uso antimicrobianos; “Proyecto Resistencia Zero”; “Zero Resistance Project”.