Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials.
OBJECTIVE
To determine whether antibiotic prophylaxis reduces respiratory tract infections and overall mortality in unselected critically ill adult patients.


METHODS
Meta-analysis of randomised controlled trials from 1984 and 1996 that compared different forms of antibiotic prophylaxis used to reduce respiratory tract infections and mortality with aggregate data and, in a subset of trials, data from individual patients.


METHODS
Unselected critically ill adult patients; 5727 patients for aggregate data meta-analysis, 4343 for confirmatory meta-analysis with data from individual patients.


METHODS
Respiratory tract infections and total mortality.


RESULTS
Two categories of eligible trials were defined: topical plus systemic antibiotics versus no treatment and topical preparation with or without a systemic antibiotic versus a systemic agent or placebo. Estimates from aggregate data meta-analysis of 16 trials (3361 patients) that tested combined treatment indicated a strong significant reduction in infection (odds ratio 0.35; 95% confidence interval 0.29 to 0.41) and total mortality (0.80; 0.69 to 0.93). With this treatment five and 23 patients would need to be treated to prevent one infection and one death, respectively. Similar analysis of 17 trials (2366 patients) that tested only topical antibiotics indicated a clear reduction in infection (0.56; 0.46 to 0.68) without a significant effect on total mortality (1.01; 0.84 to 1.22). Analysis of data from individual patients yielded similar results. No significant differences in treatment effect by major subgroups of patients emerged from the analyses.


CONCLUSIONS
This meta-analysis of 15 years of clinical research suggests that antibiotic prophylaxis with a combination of topical and systemic drugs can reduce respiratory tract infections and overall mortality in critically ill patients. This effect is significant and worth while, and it should be considered when practice guidelines are defined.
D'Amico
R
R
Mario Negri Institute for Pharmacological Research, 20157 Milan, Italy.
Pifferi
S
S
Leonetti
C
C
Torri
V
V
Tinazzi
A
A
Liberati
A
A
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000706:statistics & numerical data*; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness; D003428:Cross Infection / Q000517:prevention & control; D019049:Developed Countries; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D011786:Quality Control; D016032:Randomized Controlled Trials as Topic / Q000592:standards*; D012141:Respiratory Tract Infections / Q000517:prevention & control*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents