Selective decontamination of the digestive tract in critically ill children:  systematic review and meta-analysis.
OBJECTIVE
We examined the impact of selective decontamination of the digestive tract on morbidity and mortality in critically ill children.


METHODS
We searched MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, and previous meta-analyses.


METHODS
We included all randomized controlled trials comparing administration of enteral antimicrobials in selective decontamination of the digestive tract with or without a parenteral component with placebo or standard therapy used in the controls.


METHODS
The primary end point was the number of acquired pneumonias. Secondary end points were number of infections and overall mortality. Odds ratios were pooled with the random effect model.


RESULTS
Four randomized controlled trials including 335 patients were identified. Pneumonia was diagnosed in five of 170 patients (2.9%) for selective decontamination of the digestive tract and 16 of 165 patients (9.7%) for controls (odds ratio 0.31; 95% confidence interval 0.11-0.87; p = .027). Overall mortality for selective decontamination of the digestive tract was 13 of 170 (7.6%) vs. control, 11 of 165 (6.7%) (odds ratio 1.18; 95% confidence interval 0.50-2.76; p = .70). In three studies (n = 109), infection occurred in ten of 54 (18.5%) patients on selective decontamination of the digestive tract and 24 of 55 (43.6%) in the controls (odds ratio 0.34; 95% confidence interval 0.05-2.18; p = .25).


CONCLUSIONS
In the four available pediatric randomized controlled trials, selective decontamination of the digestive tract significantly reduced the number of children who developed pneumonia.
Pediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trst, London, United Kingdom. petroa@gosh.nhs.uk
Andy
A
Petros
Luciano
L
Silvestri
Rachelle
R
Booth
Nia
N
Taylor
Hendrick
H
van Saene
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D016001:Confidence Intervals; D016638:Critical Illness / Q000628:therapy; D003666:Decontamination; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D017053:Infection Control; D009026:Mortality; D016017:Odds Ratio; D011014:Pneumonia / Q000175:diagnosis / Q000517:prevention & control*
D000900:Anti-Bacterial Agents