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Roquilly A, Chanques G, Lasocki S, Foucrier A, Fermier B, De Courson H, Carrie C, Danguy des Deserts M, Gakuba C, Constantin JM, Lagarde K, Holleville M, Blidi S, Sossou A, Cailliez P, Monard C, Oudotte A, Mathieu C, Bourenne J, Isetta C, Perrigault PF, Lakhal K, Rouhani A, Asehnoune K, Guerci P, Tran Dinh A, Chousterman B, Cupaciu A, Dahyot-Fizelier C, Bellier R, Au Duong J, Mansour A, Morel J, Beauplet G, Vibet MA, Feuillet F, Sébille V, Leone M. Implementation of French recommendations for the prevention and the treatment of hospital-acquired pneumonia: a cluster-randomized trial. Clin Infect Dis 2020; 73:e1601-e1610. [PMID: 32970811 DOI: 10.1093/cid/ciaa1441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We determined whether an audit on the adherence to guidelines for hospital-acquired pneumonia (HAP) for can improve the outcomes of patients in intensive care units (ICUs). METHODS This study was conducted at 35 ICUs in 30 hospitals. We included consecutive adult patients hospitalized in ICUs for three days or more. After a three-month baseline period followed by the dissemination of recommendations, an audit on the compliance to recommendations (audit period) was followed by a three-month cluster-randomized trial. We randomly assigned ICUs to either audit and feedback (intervention group) or participation to a national registry (control group). The primary outcome was the duration of ICU stay. RESULTS Among 1,856 patients enrolled, 602, 669, and 585 were recruited in the baseline, audit, and intervention periods, respectively. The composite measure of compliance was 47(38-56)% in the intervention group and 42(25-53)% in the control group (p=0.001). As compared to the baseline period, the ICU length of stay was reduced by 3.2 days in the intervention group (p=0.07) and by 2.8 days in the control group (p=0.02). The duration of ICU stay was 7 (5-14) in the control group and 9 (5-20) days in the intervention group (p=0.10). After adjustment for unbalanced baseline characteristics, the hazard ratio for being discharged alive from ICU in the control group was 1.17 (95% CI, 0.69 to 2.01; p=0.10). CONCLUSIONS The publication of French guidelines for HAP was associated with a reduction of the ICU length of stay. However, the realization of an audit to improve their application did not further improve outcomes.
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Affiliation(s)
- Antoine Roquilly
- Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Nantes, France.,Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, France
| | - Gérald Chanques
- Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Montpellier, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU d'Angers, Université d'Angers, Angers, France
| | - Arnaud Foucrier
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Beaujon (AP/HP), Beaujon, France
| | - Brice Fermier
- Intensive Care Unit, Simone Veil Hospital, Blois, France
| | - Hugues De Courson
- Department of Neuro-Critical Care, Pellegrin Hospital, Bordeaux, France
| | - Cedric Carrie
- Surgical and trauma Intensive Care, Pellegrin Hospital, Bordeaux, France
| | - Marc Danguy des Deserts
- Department of Anesthesiology and Critical Care, Hospital Inter-Armée Clermont Tonnerre, Brest, France
| | - Clément Gakuba
- Department of Anesthesiology and Critical Care, CHU Caen, Caen, France
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, Hôpital Gabriel Montpied, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Kevin Lagarde
- Neuroréanimation-Anesthésie Neuroradiologie Interventionnelle, Hôpital Gabriel Montpied, CHU Clermont Ferrand, Clermont-Ferrand, France
| | | | - Sami Blidi
- Intensive Care Unit, Eaubonne Hospital, Eaubonne, France
| | - Achille Sossou
- Department of Anesthesiology and Critical Care, Emile Roux Hospital, Le Puy en Velay, France
| | | | - Celine Monard
- Department of Anesthesiology and Critical Care, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Adrien Oudotte
- Department of Neuro-Critical Care, Hospices Civils de Lyon, Lyon, France
| | - Calypso Mathieu
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, France
| | - Jeremy Bourenne
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Emergency Intensive Care Unit, Hopital la Timone, Marseille, France
| | - Christian Isetta
- Department of Anesthesiology and Cardiothoracic Intensive Care, Pierre Zobda-Quitman, Martinique, France
| | | | - Karim Lakhal
- Department of Anesthesiology and Critical Care, Guillaume and Rene Laennec Hospital, CHU Nantes, Nantes, France
| | - Armine Rouhani
- Severe Burn Intensive Care Unit, Hotel Dieu, CHU Nantes, Nantes, France
| | - Karim Asehnoune
- Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Nantes, France.,Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, France
| | - Philippe Guerci
- Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Nancy, France
| | - Alexy Tran Dinh
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Bichat (AP/ HP), Paris, France
| | - Benjamin Chousterman
- Department of Anesthesiology and Critical Care, Severe Burn Unit, Centre Hospitalier Universitaire de Lariboisiere (AP/HP), Paris, France
| | - Alexandru Cupaciu
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Saint Louis (AP/ HP), Paris, France
| | | | - Remy Bellier
- Neuro-Intensive Care Unit, Centre Hospitalier Universitaire, Poitiers, France
| | - Jonathan Au Duong
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Rangueil Hospital, Centre Hospitalier Universitaire, Toulouse, France
| | - Alexandre Mansour
- Department of Anesthesiology and Critical Care, Pontchaillou Hospital, CHU Rennes, Rennes, France
| | - Jérome Morel
- Department of Anesthesiology and Critical Care, CHU Saint Etienne, Saint Etienne, France
| | - Ghilain Beauplet
- Department of Anesthesiology, Intensive care and Perioperative medicine - Hautepierre Hospital, Strasbourg, France
| | - Marie-Anne Vibet
- Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Université de Nantes, Nantes, France.,DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France
| | - Fanny Feuillet
- DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France.,UMR INSERM U1246 - SPHERE "methodS in Patient-centered outcomes & HEalth ResEarch" Université de Nantes, Université de Tours, France
| | - Véronique Sébille
- DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France.,UMR INSERM U1246 - SPHERE "methodS in Patient-centered outcomes & HEalth ResEarch" Université de Nantes, Université de Tours, France
| | - Marc Leone
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, France
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