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

Nienke L Plantinga, Anne Marie Ga de Smet, Evelien An Oostdijk, Evert de Jonge, Christophe Camus, Wolfgang A Krueger, Dennis Bergmans, Johannes B Reitsma, Marc Jm Bonten
Clinical Microbiology and Infection 2017 September 1

OBJECTIVES: 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.


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