Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomized controlled trials.
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.
Silvestri
Luciano
L
Department of Emergency, Unit of Anaesthesia and Intensive Care, Presidio Ospedaliero di Gorizia, Via Vittorio Veneto 171, 34170, Gorizia, Italy. lucianosilvestri@yahoo.it
van Saene
Hendrik K F
HK
Milanese
Marco
M
Gregori
Dario
D
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
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents