Format

Send to

Choose Destination
Clin Microbiol Infect. 2018 May;24(5):505-513. doi: 10.1016/j.cmi.2017.08.019. Epub 2017 Sep 1.

Selective digestive and oropharyngeal decontamination in medical and surgical ICU patients: individual patient data meta-analysis.

Author information

1
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: N.L.Plantinga@umcutrecht.nl.
2
Department of Critical Care, University of Groningen, Groningen, The Netherlands.
3
Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
4
Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands.
5
Department of Infectious Diseases and Intensive Care Medicine, Pontchaillou Hospital, University Hospital Centre Rennes, Rennes, France.
6
Department of Anesthesiology and Intensive Care, Clinics of Constance, Constance, Germany.
7
Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
8
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
9
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.

Abstract

OBJECTIVES:

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) improved intensive care unit (ICU), hospital and 28-day survival in ICUs with low levels of antibiotic resistance. Yet it is unclear whether the effect differs between medical and surgical ICU patients.

METHODS:

In an individual patient data meta-analysis, we systematically searched PubMed and included all randomized controlled studies published since 2000. We performed a two-stage meta-analysis with separate logistic regression models per study and per outcome (hospital survival and ICU survival) and subsequent pooling of main and interaction effects.

RESULTS:

Six studies, all performed in countries with low levels of antibiotic resistance, yielded 16 528 hospital admissions and 17 884 ICU admissions for complete case analysis. Compared to standard care or placebo, the pooled adjusted odds ratios for hospital mortality was 0.82 (95% confidence interval (CI) 0.72-0.93) for SDD and 0.84 (95% CI 0.73-0.97) for SOD. Compared to SOD, the adjusted odds ratio for hospital mortality was 0.90 (95% CI 0.82-0.97) for SDD. The effects on hospital mortality were not modified by type of ICU admission (p values for interaction terms were 0.66 for SDD and control, 0.87 for SOD and control and 0.47 for SDD and SOD). Similar results were found for ICU mortality.

CONCLUSIONS:

In ICUs with low levels of antibiotic resistance, the effectiveness of SDD and SOD was not modified by type of ICU admission. SDD and SOD improved hospital and ICU survival compared to standard care in both patient populations, with SDD being more effective than SOD.

KEYWORDS:

Effect modification; Individual patient data meta-analysis; Intensive care unit; SDD; SOD; Selective digestive decontamination; Selective oropharyngeal decontamination

PMID:
28870727
DOI:
10.1016/j.cmi.2017.08.019
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center