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.

Abstract

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.