Administrative Health Care Annotated Bibliography

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Selective oropharyngeal decontamination versus selective digestive decontamination in critically ill patients: a meta-analysis of randomized controlled trials.

Zhao D; Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang People's Republic of China. Song J; Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang People's Republic of China. Gao X; Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang People's Republic of China. Gao F; Hebei Provincial Procurement Centers for Medical Drugs and Devices, The Second Hospital of Hebei Medical University, Shijiazhuang People's Republic of China. Wu Y; Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang People's Republic of China. Lu Y; Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang People's Republic of China. Hou K; Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang People's Republic of China.

Drug design, development and therapy [Drug Des Devel Ther] 2015 Jul 14; Vol. 9, pp. 3617-24. Date of Electronic Publication: 2015 Jul 14 (Print Publication: 2015).

Journal Article; Meta-Analysis; Review

English

Publisher: Dove Press Limited Country of Publication: New Zealand NLM ID: 101475745 Publication Model: eCollection Cited Medium: Internet ISSN: 1177-8881 (Electronic) Linking ISSN: 11778881 NLM ISO Abbreviation: Drug Des Devel Ther Subsets: MEDLINE

Original Publication: [Auckland, N.Z.] : Dove Press Limited

Anti-Bacterial Agents/*administration & dosage Cross Infection/*prevention & control Digestive System/*microbiology Oropharynx/*microbiology Respiratory Tract Infections/*prevention & control Anti-Bacterial Agents/adverse effects ; Critical Illness ; Cross Infection/diagnosis ; Cross Infection/microbiology ; Drug Administration Schedule ; Drug Resistance, Bacterial ; Hospital Mortality ; Humans ; Length of Stay ; Odds Ratio ; Randomized Controlled Trials as Topic ; Respiration, Artificial ; Respiratory Tract Infections/diagnosis ; Respiratory Tract Infections/microbiology ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome

Background: Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) are associated with reduced mortality and infection rates among patients in intensive care units (ICUs); however, whether SOD has a superior effect than SDD remains uncertain. Hence, we conducted a meta-analysis of randomized controlled trials (RCTs) to compare SOD with SDD in terms of clinical outcomes and antimicrobial resistance rates in patients who were critically ill. Methods: RCTs published in PubMed, Embase, and Web of Science were systematically reviewed to compare the effects of SOD and SDD in patients who were critically ill. Outcomes included day-28 mortality, length of ICU stay, length of hospital stay, duration of mechanical ventilation, ICU-acquired bacteremia, and prevalence of antibiotic- resistant Gram-negative bacteria. Results were expressed as risk ratio (RR) with 95% confidence intervals (CIs), and weighted mean differences (WMDs) with 95% CIs. Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. Results: A total of four RCTs involving 23,822 patients met the inclusion criteria and were included in this meta-analysis. Among patients whose admitting specialty was surgery, cardiothoracic surgery (57.3%) and neurosurgery (29.7%) were the two main types of surgery being performed. Pooled results showed that SOD had similar effects as SDD in day-28 mortality (RR = 1.03; 95% CI: 0.98, 1.08; P = 0.253), length of ICU stay (WMD = 0.00 days; 95% CI: -0.2, 0.2; P = 1.00), length of hospital stay (WMD = 0.00 days; 95% CI: -0.65, 0.65; P = 1.00), and duration of mechanical ventilation (WMD =1.01 days; 95% CI: -0.01, 2.02; P = 0.053). On the other hand, compared with SOD, SDD had a lower day-28 mortality in surgical patients (RR =1.11; 95% CI: 1.00, 1.22; P = 0.050), lower incidence of ICU-acquired bacteremia (RR = 1.38; 95% CI: 1.24, 1.54; P = 0.000), and lower rectal carriage of aminoglycosides (RR = 2.08; 95% CI: 1.68, 2.58; P = 0.000), ciprofloxacin-resistant Gram-negative bacteria (RR = 1.84; 95% CI: 1.48, 2.29; P = 0.000), and respiratory carriage of third- generation cephalosporin-resistant Gram-negative bacteria (RR = 2.50; 95% CI: 1.78, 3.5; P = 0.000). Conclusion: SOD has similar effects as SDD in clinical outcomes, but has higher incidence of ICU-acquired bacteremia, and higher carriage of antibiotic-resistant Gram-negative bacteria. However, due to the high cost of SDD and the increased risk of development of antibiotic resistance with the widespread use of cephalosporins in SDD, we would recommend SOD as prophylactic antibiotic regimens in patients in the ICU. More well-designed, large-scale RCTs are needed to confirm our findings.

BMJ. 2014;348:g2197. (PMID: 24687313) Intensive Care Med. 2010 Aug;36(8):1394-402. (PMID: 20232045) Lancet. 2003 Jun 14;361(9374):2068-77. (PMID: 12814731) Clin Infect Dis. 2009 Oct 15;49(8):1175-84. (PMID: 19739972) J Antimicrob Chemother. 2014 Mar;69(3):797-804. (PMID: 24144922) JAMA. 2014 Oct 8;312(14):1429-37. (PMID: 25271544) Am J Respir Crit Care Med. 2010 Mar 1;181(5):452-7. (PMID: 19965807) Control Clin Trials. 1986 Sep;7(3):177-88. (PMID: 3802833) Arch Surg. 1999 Feb;134(2):170-6. (PMID: 10025458) N Engl J Med. 2009 Jan 1;360(1):20-31. (PMID: 19118302) JAMA. 2009 Dec 2;302(21):2323-9. (PMID: 19952319) BMJ. 2003 Sep 6;327(7414):557-60. (PMID: 12958120) J Hyg (Lond). 1971 Sep;69(3):405-11. (PMID: 4999450) Br J Surg. 2012 Feb;99(2):232-7. (PMID: 22021072) Lancet Infect Dis. 2011 May;11(5):372-80. (PMID: 21420908) Intensive Care Med. 2013 Apr;39(4):653-60. (PMID: 23203301) Lancet. 1993 Feb 13;341(8842):418-22. (PMID: 8094183) Am J Respir Crit Care Med. 2001 Aug 1;164(3):382-8. (PMID: 11500337) Control Clin Trials. 1996 Feb;17(1):1-12. (PMID: 8721797) Intensive Care Med. 1984;10(4):185-92. (PMID: 6470306) BMJ Open. 2013 Mar 05;3(3):null. (PMID: 23468472) Ann Intern Med. 2001 Dec 4;135(11):982-9. (PMID: 11730399) Lancet Infect Dis. 2013 Apr;13(4):328-41. (PMID: 23352693) Lancet. 2003 Sep 27;362(9389):1011-6. (PMID: 14522530) PLoS Med. 2009 Jul 21;6(7):e1000097. (PMID: 19621072)

Keywords: intensive care units; meta-analysis; selective digestive decontamination; selective oropharyngeal decontamination

0 (Anti-Bacterial Agents)

Date Created: 20150724 Date Completed: 20160407 Latest Revision: 20181113

20211106

PMC4507487

10.2147/DDDT.S84587

26203227

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