title: Single-drug therapy or selective decontamination of the digestive tract as antifungal prophylaxis in critically ill patients: a systematic review.
abstract: BACKGROUND
  The objective of this study was to determine and compare the effectiveness of different prophylactic antifungal therapies in critically ill patients on the incidence of yeast colonisation, infection, candidemia, and hospital mortality.
  
  
  METHODS
  A systematic review was conducted of prospective trials including adult non-neutropenic patients, comparing single-drug antifungal prophylaxis (SAP) or selective decontamination of the digestive tract (SDD) with controls and with each other.
  
  
  RESULTS
  Thirty-three studies were included (11 SAP and 22 SDD; 5,529 patients). Compared with control groups, both SAP and SDD reduced the incidence of yeast colonisation (SAP: odds ratio [OR] 0.38, 95% confidence interval [CI] 0.20 to 0.70; SDD: OR 0.12, 95% CI 0.05 to 0.29) and infection (SAP: OR 0.54, 95% CI 0.39 to 0.75; SDD: OR 0.29, 95% CI 0.18 to 0.45). Treatment effects were significantly larger in SDD trials than in SAP trials. The incidence of candidemia was reduced by SAP (OR 0.32, 95% CI 0.12 to 0.82) but not by SDD (OR 0.59, 95% CI 0.25 to 1.40). In-hospital mortality was reduced predominantly by SDD (OR 0.73, 95% CI 0.59 to 0.93, numbers needed to treat 15; SAP: OR 0.80, 95% CI 0.64 to 1.00). Effectiveness of prophylaxis reduced with an increased proportion of included surgical patients.
  
  
  CONCLUSIONS
  Antifungal prophylaxis (SAP or SDD) is effective in reducing yeast colonisation and infections across a range of critically ill patients. Indirect comparisons suggest that SDD is more effective in reducing yeast-related outcomes, except for candidemia.
authors: Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors: Jw Olivier
authors: JO
authors: van Till
authors: Oddeke
authors: O
authors: van Ruler
authors: Bas
authors: B
authors: Lamme
authors: Roy J P
authors: RJ
authors: Weber
authors: Johannes B
authors: JB
authors: Reitsma
authors: Marja A
authors: MA
authors: Boermeester
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage*; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D016638:Critical Illness / Q000401:mortality*; D003666:Decontamination / Q000379:methods*; D041981:Gastrointestinal Tract / Q000187:drug effects* / Q000382:microbiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans
chemical_list: D000935:Antifungal Agents