title: Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomized controlled trials.
abstract: OBJECTIVE
  To determine the impact of the antifungal component of selective decontamination of the digestive tract on fungal carriage, infection and fungaemia.
  
  
  METHODS
  Meta-analysis of randomized controlled trials of selective decontamination of the digestive tract.
  
  
  METHODS
  Data sources included Medline, Embase, Cochrane Register of Controlled Trials, previous meta-analyses, personal communications and conference proceedings, without restriction of language or publication status. All randomized trials were selected that compared oropharyngeal and/or intestinal administration of antifungals amphotericin B or nystatin, as part of selective decontamination protocol, with no treatment in the controls. There were 42 randomized controlled trials with a total of 6,075 critically ill patients.
  
  
  METHODS
  Three reviewers independently applied selection criteria, performed quality assessment and extracted the data. The main outcome measures were patients with fungal carriage, patients with fungal infections and patients with fungaemia. Odds ratios were pooled with the random effect model.
  
  
  RESULTS
  Enteral antifungals significantly reduced fungal carriage (odds ratio 0.32, 95% confidence interval 0.19-0.53) and overall fungal infections (0.30, 0.17-0.53). Fungaemia was not significantly reduced in the treatment group (0.89, 0.16-4.95).
  
  
  CONCLUSIONS
  Antifungals, as part of selective decontamination of the digestive tract, reduce fungal carriage and infection but not fungaemia in critically ill patients and may justify the inclusion of an antifungal component in the decontamination protocol.
authors.affiliation: Department of Emergency, Unit of Anaesthesia and Intensive Care, Presidio Ospedaliero di Gorizia, Via Vittorio Veneto 171, 34170, Gorizia, Italy. lucianosilvestri@yahoo.it
authors.forename: Luciano
authors.initials: L
authors.lastname: Silvestri
authors.forename: Hendrik K F
authors.initials: HK
authors.lastname: van Saene
authors.forename: Marco
authors.initials: M
authors.lastname: Milanese
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000188:drug therapy* / Q000517:prevention & control; D003666:Decontamination / Q000379:methods*; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D009181:Mycoses / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents