Clinical Microbiology and Infection
Clinical Microbiology and Infection
5 years ago

Selective Digestive and Oropharyngeal Decontamination in medical and surgical ICU-patients; an individual patient data meta-analysis

Selective Digestive Decontamination (SDD) and Selective Oropharyngeal Decontamination (SOD) improved ICU, hospital and 28-day survival in Intensive Care Units (ICU) with low levels of antibiotic resistance. Yet, it is unclear whether the effect differs between medical and surgical ICU patients. Methods In an individual patient data meta-analysis we systematically searched PubMed and included all randomized controlled studies published since 2000. We performed a two-stage meta-analysis with separate logistic regression models per study and per outcome (hospital survival and ICU survival) and subsequent pooling of main and interaction effects. Results Six studies, all performed in countries with low levels of antibiotic resistance, yielded 16,528 hospital admissions and 17,884 ICU-admissions for complete case analysis. Compared to standard care or placebo the pooled adjusted odds ratios (aOR) for hospital mortality was 0·82 (95% Confidence Interval [CI] 0·72 – 0·93) for SDD and 0·84 (95%-CI 0·73 – 0·97) for SOD. Compared to SOD the aOR for hospital mortality was 0·90 (95%-CI 0·82 – 0·97) for SDD. The effects on hospital mortality were not modified by type of ICU-admission (p-values for interaction terms were 0·66 for SDD and control, 0·87 for SOD and control, and 0·47 for SDD and SOD). Similar results were found for ICU mortality. Conclusions In ICUs with low levels of antibiotic resistance, the effectiveness of SDD and SOD was not modified by type of ICU-admission. SDD and SOD improved hospital and ICU survival, compared to standard care, with SDD being more effective than SOD, in both patient populations.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17304779

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