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Infection prevention and control measures for multidrug-resistant organisms: a systematic review and network meta-analysis.

Background: The effectiveness of infection prevention and control measures combating multidrug-resistant organisms (MDROs) in healthcare settings remains controversial. Methods: PubMed, Embase, MEDLINE, Cochrane Library, and CINAHL were searched from inception to June 1, 2024. The interventions enco...

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Published in:Infection Vol. 53; no. 5; pp. 1789 - 1801
Main Authors: Geng, Yuhui, Liu, Zhuo, Ma, Xiaojuan, Pan, Ting, Chen, Mingbo, Dang, Jingxia, Zhang, Ping, Chen, Chen, Zhao, Yuan, Pan, Dongfeng, Liang, Peifeng
Format: meta analysis research systematic review tables/charts Journal Article
Published: Springer Nature Oct2025
Online Access:View this record in EBSCOhost
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      dt: Oct2025
      vid: 53
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      pub: Springer Nature
      place: New York, New York
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        10.1007/s15010-025-02498-9
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        atl: Infection prevention and control measures for multidrug-resistant organisms: a systematic review and network meta-analysis.
      aug:
        au:
          Geng, Yuhui
          Liu, Zhuo
          Ma, Xiaojuan
          Pan, Ting
          Chen, Mingbo
          Dang, Jingxia
          Zhang, Ping
          Chen, Chen
          Zhao, Yuan
          Pan, Dongfeng
          Liang, Peifeng
        affil: https://ror.org/02h8a1848 School of Public Health, Ningxia Medical University, Yinchuan, China
      sug:
        subj:
          Cross Infection Prevention and Control
          Drug Resistance, Microbial
          Drug Resistance, Multiple
          Infection Control Methods
          Hospitalization
          Intensive Care Units
          Health Facility Environment
          Human
          Funding Source
          Systematic Review
          PubMed
          Embase
          Medline
          Cochrane Library
          CINAHL Database
          Meta Analysis
          Descriptive Statistics
          Confidence Intervals
          Inpatients
          Handwashing
          Universal Precautions
          Bacterial Colonization
          Chlorhexidine Therapeutic Use
          Carbapenem-Resistant Enterobacteriaceae
      ab: Background: The effectiveness of infection prevention and control measures combating multidrug-resistant organisms (MDROs) in healthcare settings remains controversial. Methods: PubMed, Embase, MEDLINE, Cochrane Library, and CINAHL were searched from inception to June 1, 2024. The interventions encompassed standard precautions (SP), contact precautions (CP), hand hygiene (HH), environmental cleaning (ENV), antimicrobial stewardship programs (ASP), decolonization (DCL), and chlorhexidine baths (CHG). The primary outcome were the acquisition, infection, and colonization of MDROs. Secondary outcomes were all-cause mortality and MDROs-associated bacteraemia. Effect indicators were expressed as rate ratios (RRs) with 95% confidence intervals (CIs). Results: The study included a total of 97 articles, comprising 19 RCTs and 78 non-RCTs. The results showed that the most effective combination interventions for the acquisition, infection, and colonization of MDROs compared to SP varied as follows: CP + CHG (RR, 0.38 [0.18, 0.79]), SP + CP + ENV (RR, 0.04 [0.02, 0.08]), and SP + CHG (RR, 0.28 [0.14, 0.56]). In subgroup analyses, CP + CHG (RR, 0.36 [0.20,0.64]) was the most effective intervention for the acquisition of MDROs in the ICU setting, whereas SP + CP + ASP (RR, 0.35 [0.14,0.92]) was the most effective hospital-wide. Across subgroups, SP + CP + ENV (RR, 0.04 to 0.09 [95% CI, 0.01 to 0.99]) was identified as the most effective intervention for MDROs infections. In the ICU setting, SP + CHG (RR, 0.28 [0.14,0.56]) demonstrated the highest effectiveness in reducing the colonization of MDROs, whereas SP + CP + ENV + CHG (RR, 0.15 [0.06,0.38]) was the most effective on a hospital-wide scale. SP + CP + DCL (RR, 0.28 [0.24, 0.32]) was associated with reduced CRE colonization. The results of this study were robust according to the sensitivity analysis. None of the analyses related to secondary outcomes were statistically significant. In terms of article quality assessment, 94.7% of the RCTs were medium to high risk, while 92.31% of the non-RCTs. The primary limitation of the RCTs were related to the randomization process, whereas the non-RCTs were primarily affected by confounding bias. Conclusions: Effective interventions differ based on carriage status, intervention setting, and the resistant strain. Additionally, contact precautions is a crucial component of these combinations. Consequently, healthcare organizations can select appropriate interventions based on their unique resistance profiles to optimize precision and resource efficiency.
      pubtype: Academic Journal
      doctype:
        meta analysis
        research
        systematic review
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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