Structural equation modeling the “control of gut overgrowth” in the prevention of ICU-acquired Gram-negative infection

Abstract Background Conceptually, the “control of gut overgrowth” (COGO) is key in mediating prevention against infection with Gram-negative bacilli by topical antibiotic prophylaxis, a common constituent of selective digestive decontamination (SDD) regimens. However, the relative importance of the...

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Main Author: James C. Hurley
Format: Article
Language:English
Published: BMC 2020-05-01
Series:Critical Care
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13054-020-02906-6
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author James C. Hurley
author_facet James C. Hurley
author_sort James C. Hurley
collection DOAJ
description Abstract Background Conceptually, the “control of gut overgrowth” (COGO) is key in mediating prevention against infection with Gram-negative bacilli by topical antibiotic prophylaxis, a common constituent of selective digestive decontamination (SDD) regimens. However, the relative importance of the other SDD components, enteral and protocolized parenteral antibiotic prophylaxis, versus other methods of infection prevention and versus other contextual exposures cannot be resolved within individual studies. Methods Seven candidate generalized structural equation models founded on COGO concepts were confronted with Pseudomonas and Acinetobacter bacteremia as well as ventilator-associated pneumonia data derived from > 200 infection prevention studies. The following group-level exposures were included in the models: use and mode of antibiotic prophylaxis, anti-septic and non-decontamination methods of infection prevention; proportion receiving mechanical ventilation; trauma ICU; mean length of ICU stay; and concurrency versus non-concurrency of topical antibiotic prophylaxis study control groups. Results In modeling Pseudomonas and Acinetobacter gut overgrowth as latent variables, anti-septic interventions had the strongest negative effect against Pseudomonas gut overgrowth but no intervention was significantly negative against Acinetobacter gut overgrowth. Strikingly, protocolized parenteral antibiotic prophylaxis and concurrency each have positive effects in the model, enteral antibiotic prophylaxis is neutral, and Acinetobacter bacteremia incidences are high within topical antibiotic prophylaxis studies, moreso with protocolized parenteral antibiotic prophylaxis exposure. Paradoxically, topical antibiotic prophylaxis (moreso with protocolized parenteral antibiotic prophylaxis) appears to provide the strongest summary prevention effects against overall bacteremia and overall VAP. Conclusions Structural equation modeling of published Gram-negative bacillus infection data enables a test of the COGO concept. Paradoxically, Acinetobacter and Pseudomonas bacteremia incidences are unusually high among studies of topical antibiotic prophylaxis.
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spelling doaj.art-d6e021e683aa4ec0b437e9954c0e912e2022-12-22T01:16:07ZengBMCCritical Care1364-85352020-05-0124111210.1186/s13054-020-02906-6Structural equation modeling the “control of gut overgrowth” in the prevention of ICU-acquired Gram-negative infectionJames C. Hurley0Melbourne Medical School, University of MelbourneAbstract Background Conceptually, the “control of gut overgrowth” (COGO) is key in mediating prevention against infection with Gram-negative bacilli by topical antibiotic prophylaxis, a common constituent of selective digestive decontamination (SDD) regimens. However, the relative importance of the other SDD components, enteral and protocolized parenteral antibiotic prophylaxis, versus other methods of infection prevention and versus other contextual exposures cannot be resolved within individual studies. Methods Seven candidate generalized structural equation models founded on COGO concepts were confronted with Pseudomonas and Acinetobacter bacteremia as well as ventilator-associated pneumonia data derived from > 200 infection prevention studies. The following group-level exposures were included in the models: use and mode of antibiotic prophylaxis, anti-septic and non-decontamination methods of infection prevention; proportion receiving mechanical ventilation; trauma ICU; mean length of ICU stay; and concurrency versus non-concurrency of topical antibiotic prophylaxis study control groups. Results In modeling Pseudomonas and Acinetobacter gut overgrowth as latent variables, anti-septic interventions had the strongest negative effect against Pseudomonas gut overgrowth but no intervention was significantly negative against Acinetobacter gut overgrowth. Strikingly, protocolized parenteral antibiotic prophylaxis and concurrency each have positive effects in the model, enteral antibiotic prophylaxis is neutral, and Acinetobacter bacteremia incidences are high within topical antibiotic prophylaxis studies, moreso with protocolized parenteral antibiotic prophylaxis exposure. Paradoxically, topical antibiotic prophylaxis (moreso with protocolized parenteral antibiotic prophylaxis) appears to provide the strongest summary prevention effects against overall bacteremia and overall VAP. Conclusions Structural equation modeling of published Gram-negative bacillus infection data enables a test of the COGO concept. Paradoxically, Acinetobacter and Pseudomonas bacteremia incidences are unusually high among studies of topical antibiotic prophylaxis.http://link.springer.com/article/10.1186/s13054-020-02906-6BacteremiaAcinetobacterPseudomonasAntibiotic prophylaxisStudy designIntensive care
spellingShingle James C. Hurley
Structural equation modeling the “control of gut overgrowth” in the prevention of ICU-acquired Gram-negative infection
Critical Care
Bacteremia
Acinetobacter
Pseudomonas
Antibiotic prophylaxis
Study design
Intensive care
title Structural equation modeling the “control of gut overgrowth” in the prevention of ICU-acquired Gram-negative infection
title_full Structural equation modeling the “control of gut overgrowth” in the prevention of ICU-acquired Gram-negative infection
title_fullStr Structural equation modeling the “control of gut overgrowth” in the prevention of ICU-acquired Gram-negative infection
title_full_unstemmed Structural equation modeling the “control of gut overgrowth” in the prevention of ICU-acquired Gram-negative infection
title_short Structural equation modeling the “control of gut overgrowth” in the prevention of ICU-acquired Gram-negative infection
title_sort structural equation modeling the control of gut overgrowth in the prevention of icu acquired gram negative infection
topic Bacteremia
Acinetobacter
Pseudomonas
Antibiotic prophylaxis
Study design
Intensive care
url http://link.springer.com/article/10.1186/s13054-020-02906-6
work_keys_str_mv AT jameschurley structuralequationmodelingthecontrolofgutovergrowthinthepreventionoficuacquiredgramnegativeinfection