title: Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized, controlled trials.
abstract: 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.
authors.affiliation: Department of Anaesthesia and Intensive Care, Presidio Ospedaliero, Gorizia, Italy. lucianosilvestri@yahoo.it
authors.forename: L
authors.initials: L
authors.lastname: Silvestri
authors.forename: H K F
authors.initials: HK
authors.lastname: van Saene
authors.forename: M
authors.initials: M
authors.lastname: Milanese
authors.forename: D
authors.initials: D
authors.lastname: Gregori
authors.forename: A
authors.initials: A
authors.lastname: Gullo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D003428:Cross Infection / Q000517:prevention & control*; D003666:Decontamination / Q000379:methods*; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000382:microbiology; D041981:Gastrointestinal Tract / Q000382:microbiology; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents