Rebound Inverts the <i>Staphylococcus aureus</i> Bacteremia Prevention Effect of Antibiotic Based Decontamination Interventions in ICU Cohorts with Prolonged Length of Stay

• Main Author: James Hurley (Author)
• Format: Book
• Published: MDPI AG, 2024-03-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Could rebound explain the paradoxical lack of prevention effect against <i>Staphylococcus aureus</i> blood stream infections (BSIs) with antibiotic-based decontamination intervention (BDI) methods among studies of ICU patients within the literature? Two meta-regression models were applied, each versus the group mean length of stay (LOS). Firstly, the prevention effects against <i>S. aureus</i> BSI [and <i>S. aureus</i> VAP] among 136 studies of antibiotic-BDI versus other interventions were analyzed. Secondly, the <i>S. aureus</i> BSI [and <i>S. aureus</i> VAP] incidence in 268 control and intervention cohorts from studies of antibiotic-BDI versus that among 165 observational cohorts as a benchmark was modelled. In model one, the meta-regression line versus group mean LOS crossed the null, with the antibiotic-BDI prevention effect against <i>S. aureus</i> BSI at mean LOS day 7 (OR 0.45; 0.30 to 0.68) inverted at mean LOS day 20 (OR 1.7; 1.1 to 2.6). In model two, the meta-regression line versus group mean LOS crossed the benchmark line, and the predicted <i>S. aureus</i> BSI incidence for antibiotic-BDI groups was 0.47; 0.09-0.84 percentage points below versus 3.0; 0.12-5.9 above the benchmark in studies with 7 versus 20 days mean LOS, respectively. Rebound within the intervention groups attenuated and inverted the prevention effect of antibiotic-BDI against <i>S. aureus</i> VAP and BSI, respectively. This explains the paradoxical findings.

Item Description

10.3390/antibiotics13040316
2079-6382