Impact of selective digestive decontamination on respiratory tract Candida among patients with suspected ventilator-associated pneumonia. A meta-analysis.
The purpose here is to establish the incidence of respiratory tract colonization with Candida (RT Candida) among ICU patients receiving mechanical ventilation within studies in the literature. Also of interest is its relationship with candidemia and the relative importance of topical antibiotic (TA) use as within studies of selective digestive decontamination (SDD) versus other candidate risk factors towards it. The incidence of RT Candida was extracted from component (control and intervention) groups decanted from studies of various TA and non-TA ICU infection prevention methods with summary estimates derived using random effects. A benchmark RT Candida incidence to provide overarching calibration was derived using (observational) groups from studies without any prevention method under study. A multi-level regression model of group level data was undertaken using generalized estimating equation (GEE) methods. RT Candida data were sourced from 113 studies. The benchmark RT Candida incidence is 1.3; 0.9-1.8 % (mean and 95 % confidence intervals). Membership of a concurrent control group of a study of SDD (p = 0.02), the group-wide presence of candidemia risk factors (p < 0.001), and proportion of trauma admissions (p = 0.004), but neither the year of study publication, nor membership of any other component group, nor the mode of respiratory sampling are predictive of the RT Candida incidence. RT Candida and candidemia incidences are correlated. RT Candida incidence can serve as a basis for benchmarking. Several relationships have been identified. The increased incidence among concurrent control groups of SDD studies cannot be appreciated in any single study examined in isolation.
Department of Rural Health, Melbourne Medical School, University of Melbourne, Parkville, Australia. jamesh@bhs.org.au.|Internal Medicine Service Ballarat Health Services, PO Box 577, Ballarat, Australia, 3353. jamesh@bhs.org.au.|Infection Control Committees, St John of God Hospital and Ballarat Health Services, Ballarat, Victoria, Australia. jamesh@bhs.org.au.
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D002175:Candida; D058387:Candidemia; D002177:Candidiasis / Q000382:microbiology*; D002353:Carrier State; D003666:Decontamination / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000209:etiology*; D012121:Respiration, Artificial / Q000009:adverse effects; D012137:Respiratory System / Q000382:microbiology*