Infection prevention strategies for carbapenem-resistant and ESBL-producing gram-negative bacteria in intensive care units: A systematic review with exploratory component network meta-analysis.

BACKGROUND

Health care-associated infections caused by multidrug-resistant gram-negative bacteria remain a major challenge in intensive care units (ICUs). Although infection prevention and control (IPC) bundles are widely used, the contribution of individual components remains uncertain.

METHODS

We performed a systematic review of interventional studies evaluating IPC strategies in adult ICUs and an exploratory component network meta-analysis (CNMA). The primary outcome was acquisition of carbapenem-resistant gram-negative bacilli or extended-spectrum β-lactamase-producing Enterobacterales during ICU stay. Standard precautions (SP) were the reference, and certainty of evidence was assessed using GRADE.

RESULTS

Seventeen studies met the inclusion criteria, and 12 contributed to the CNMA (36,264 patients; 2,542 acquisition events). Compared with SP, two multimodal strategies reduced acquisition: active surveillance, chlorhexidine bathing, contact precautions, and enhanced environmental cleaning (RR 0.34, 95% CI 0.14-0.82), and chlorhexidine bathing plus decolonization (RR 0.39, 95% CI 0.18-0.84). No individual IPC component showed a significant independent effect. Certainty of evidence was low because of heterogeneity, indirectness, and imprecision.

CONCLUSIONS

Multimodal IPC strategies may reduce acquisition of multidrug-resistant gram-negative organisms in ICUs, whereas isolated interventions beyond SP provide uncertain benefit. Findings should be interpreted cautiously because of substantial clinical heterogeneity and low-certainty evidence.