Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized, controlled trials

Summary A systematic review and meta-analysis of randomized controlled trials (RCTs) of selective decontamination of the digestive tract (SDD) was undertaken to evaluate the impact of this procedure on bacterial bloodstream infection and mortality. Data sources were Medline, Embase, Cochrane Registe...

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Bibliographic Details
Published in:The Journal of hospital infection 2007-03, Vol.65 (3), p.187-203
Main Authors: Silvestri, L, van Saene, H.K.F, Milanese, M, Gregori, D, Gullo, A
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Antibacterial agents
Antibiotic Prophylaxis
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antifungal Agents - therapeutic use
Bacteremia - microbiology
Bacteremia - mortality
Bacteremia - prevention & control
Bacterial diseases
Bacterial sepsis
Biological and medical sciences
Bloodstream infections
Critical Illness - mortality
Critical Illness - therapy
Cross Infection - prevention & control
Decontamination - methods
Epidemiology. Vaccinations
Gastrointestinal Diseases - drug therapy
Gastrointestinal Diseases - microbiology
Gastrointestinal Tract - microbiology
General aspects
Human bacterial diseases
Humans
Infection
Infection Control - methods
Infectious Disease
Infectious diseases
Intensive care
Intensive Care Units
Medical sciences
Pharmacology. Drug treatments
Randomized Controlled Trials as Topic
Selective decontamination
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Summary:Summary A systematic review and meta-analysis of randomized controlled trials (RCTs) of selective decontamination of the digestive tract (SDD) was undertaken to evaluate the impact of this procedure on bacterial bloodstream infection and mortality. Data sources were Medline, Embase, Cochrane Register of Controlled Trials, previous meta-analyses, and conference proceedings, without restriction of language or publication status. RCTs were retrieved that compared oropharyngeal and/or intestinal administration of antibiotics as part of the SDD protocol, with or without a parenteral component, with no treatment or placebo in the controls. The three outcome measures were patients with bloodstream infection, causative micro-organisms, and total mortality. Fifty-one RCTs conducted between 1987 and 2005, comprising 8065 critically ill patients were included in the review; 4079 patients received SDD and 3986 were controls. SDD significantly reduced overall bloodstream infections [odds ratio (OR), 0.73; 95% confidence interval (CI), 0.59–0.90; P = 0.0036], Gram-negative bloodstream infections (OR, 0.39; 95% CI, 0.24–0.63; P < 0.001) and overall mortality (OR, 0.80; 95% CI, 0.69–0.94; P = 0.0064), without affecting Gram-positive bloodstream infections (OR, 1.06; 95% CI, 0.77–1.47). The subgroup analysis showed an even larger impact of SDD using parenteral and enteral antimicrobials on overall bloodstream infections, bloodstream infections due to Gram-negative bacteria and overall mortality with ORs of 0.63 (95% CI, 0.46–0.87; P = 0.005), 0.30 (95% CI, 0.16–0.56; P < 0.001), and 0.74 (95% CI, 0.61–0.91; P = 0.0034), respectively. Twenty patients need to be treated with SDD to prevent one Gram-negative bloodstream infection and 22 patients to prevent one death.
ISSN:0195-6701
1532-2939
DOI:10.1016/j.jhin.2006.10.014