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Intensive Care Medicine

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01-07-2005 | Systematic Review

Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomized controlled trials

Authors: Luciano Silvestri, Hendrik K. F. van Saene, Marco Milanese, Dario Gregori

Published in: Intensive Care Medicine | Issue 7/2005

Abstract

Objective

To determine the impact of the antifungal component of selective decontamination of the digestive tract on fungal carriage, infection and fungaemia.

Design

Meta-analysis of randomized controlled trials of selective decontamination of the digestive tract

Study selection

Data sources included Medline, Embase, Cochrane Register of Controlled Trials, previous meta-analyses, personal communications and conference proceedings, without restriction of language or publication status. All randomized trials were selected that compared oropharyngeal and/or intestinal administration of antifungals amphotericin B or nystatin, as part of selective decontamination protocol, with no treatment in the controls. There were 42 randomized controlled trials with a total of 6,075 critically ill patients.

Methods

Three reviewers independently applied selection criteria, performed quality assessment and extracted the data. The main outcome measures were patients with fungal carriage, patients with fungal infections and patients with fungaemia. Odds ratios were pooled with the random effect model.

Measurements and results

Enteral antifungals significantly reduced fungal carriage (odds ratio 0.32, 95% confidence interval 0.19–0.53) and overall fungal infections (0.30, 0.17–0.53). Fungaemia was not significantly reduced in the treatment group (0.89, 0.16–4.95).

Conclusions

Antifungals, as part of selective decontamination of the digestive tract, reduce fungal carriage and infection but not fungaemia in critically ill patients and may justify the inclusion of an antifungal component in the decontamination protocol.

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Title: Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomized controlled trials
Authors: Luciano Silvestri
Hendrik K. F. van Saene
Marco Milanese
Dario Gregori
Publication date: 01-07-2005
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 7/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-005-2654-9

At a glance: The STEP trials

Springer Medicine

Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomized controlled trials

Abstract

Objective

Design

Study selection

Methods

Measurements and results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design

Study selection

Methods

Measurements and results

Conclusions

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Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients

Pushing the boundaries for the use of ECMO in acute hypoxic respiratory failure

A patient with severe lactic acidosis and rapidly evolving multiple organ failure: a case of shoshin beri-beri

A pilot study of inhaled nitric oxide in preterm infants treated with nasal continuous positive airway pressure for respiratory distress syndrome