Purpose: To review available clinical trials of selective digestive decontamination (SDD) in patients requiring intensive care.

Data sources: All relevant English-language articles from 1982 from one side 1992 were identified through MEDLINE search and article bibliographies.

inquiry selection: Twenty-one articles were identified; 16 articles were picked for analysis based on inclusion and exclusion criteria.

Data extraction: casualty rates for mortality, acquired pneumonia, and acquired tracheobronchitis were extracted for patients treated with SDD and for sway patients. Cumulative risk differences were calculated for each of these outcomes

Results: There was no significant difference between cumulative mortality rates for have the direction of patients (0.262; n=1,165) and patients receiving SDD (0243; n=1105) (p=0291; beta error rate=0.16). The acquired pneumonia rate in command patients (0.219; n=1,097) was significantly greater than that in patients receiving SDD (0074; n=1031) (p [les than] 00001) The acquired tracheobronchitis rate in command patients (0.117; n=549) was also significantly greater than that in patients receiving SDD (0065; n=494) (p=0004) The rate of acquired pneumonia fit to Gram-positive bacteria was similar between the govern patients (0.033; n=660) and the SDD-treated patients (0033; n=646) (p=0933) Colonization with pathogenic Gram-positive bacteria and pneumonia becoming to antibiotic-resistant Gram-positive bacteria appeared to offer more frequently in SDD-treated patients.

Conclusions: These rises suggest that SDD decreases the overall incidence of acquired pneumonia and tracheobronchitis in patients requiring intensive care. SDD had no apparent drift on the hospital mortality rate. The routine use of SDD cannot be supported through this meta-analysis. SDD may be useful in specific circumstances where a particular ICU or ICU population is set up to have an excessive incidence of acquired infections. Any use of SDD should include careful patient surveillance for the emerging see the verb of infection due to bacteria not masked by the prophylaxis regimen and to be paid to antibiotic-resistant bacteria.

Nosocomial pneumonia accounts for 13 to 18 percent of all nosocomial infections in the United States and is the leading cause of patient mortality resulting from nosocomial infection.[1-3] The incidence of nosocomial pneumonia in ICUs ranges from 10 to 65 percent with case fatality rates of 13 to 55 percent[4-14] The pathogenesis of nosocomial pneumonia may hang on specific risk factors that predispose to gastric and oropharyngeal colonization with aerobic Gram-negative bacilli.[3,15] Aspirating these organisms into the lower respiratory tract can, in specific circumstances, overwhelm normal army defenses and lead to pneumonia. Logically, then, the order of selective digestive decontamination (SDD) should decrease the incidence of nosocomial infections, particularly nosocomial pneumonia, in critically ill patients.[16] The goal of SDD is to obstruct colonization of the oropharynx and the digestive tract with these potentially pathogenic bacteria by way of using specifically designed antibiotic regimens that are administered prophylactically.[16] These antibiotic regimens have usually targeted aerobic Gram-negative bacilli and fungi.[15,16]

Several reviews and analyses of SDD have been published recently[17-23] These reviews refer to that SDD may be beneficial in space of times of decreasing nosocomial infections, although the weights of SDD on mortality appear to be les clear. Several of these reviews appear to advocate the use of SDD especially in trauma patients,[17,19,20] while others allude to that further investigations are required to identify clear issue benefits from the use of SDD[1823] Since the publication of these reviews,[17-23] four fresh prospective clinical trials of SDD have been published. To further address the issue of SDD in light of these strange data, a meta-analysis was performed.

MATERIALS AND METHODS

The goal of this meta-analysis was to identify and analyze relevant issue studies of SDD performed in general ICU populations. For objects of this analysis, general ICU populations were defined as those comprised of medical, surgical, and trauma patients. Studies involving organ transplant patients and consume patients were not reviewed. Twenty-one English-language studies of SDD prophylaxis[24-44] were initially identified and reviewed using a data extraction form previously described.[45] These articles were obtained from a MEDLINE search as well as from review of the bibliographies of relevant original investigations and review articles. Prospectively delineated criteria for inclusion of a application of mind into the meta-analysis were the following: publication in an English-language journal; patient selection for SDD administration via a prospective randomization protocol; use of patient mortality as an result measure; and sample sizes greater than ten by randomization group. Studies were exclud from analysis no other than if they used historical bridles (four studies[24-27]) or if SDD administration was not performed randomly (one study)[28]

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