THE ROLE OF SELECTIVE DIGESTIVE-TRACT DECONTAMINATION ON MORTALITY AND RESPIRATORY-TRACT INFECTIONS - A METAANALYSIS

Purpose: To review available clinical trials of selective digestive de contamination (SDD) in patients requiring intensive care. Data sources : All relevant English-language articles from 1982 through 1992 were i dentified through MEDLINE search and article bibliographies. Study sel ection: Twenty-one articles were identified; 16 articles were selected for analysis based on inclusion and exclusion criteria. Data extracti on: Occurrence rates for mortality, acquired pneumonia, and acquired t racheobronchitis were extracted for patients treated with SDD and for control patients. Cumulative risk differences were calculated for each of these outcomes. Results: There was no significant difference betwe en cumulative mortality rates for control patients (0.262; n=1,165) an d patients receiving SDD (0.243; n=1,105) (p=0.291; beta error rate=0. 16). The acquired pneumonia rate in control patients (0.219; n=1,097) was significantly greater than that in patients receiving SDD (0.074; n=1,031) (p<0.0001). The acquired tracheobronchitis rate in control pa tients (0.117; n=549) was also significantly greater than that in pati ents receiving SDD (0.065; n=494) (p=0.004). The rate of acquired pneu monia due to Grampositive bacteria was similar between the control pat ients (0.033; n=660) and the SDD-treated patients (0.033; n=646) (p=0. 933). Colonization with pathogenic Grampositive bacteria and pneumonia due to antibiotic-resistant Gram-positive bacteria appeared to occur more frequently in SDD-treated patients. Conclusions: These results su ggest that SDD decreases the overall incidence of acquired pneumonia a nd tracheobronchitis in patients requiring intensive care. SDD had no apparent effect on the hospital mortality rate. The routine use of SDD cannot be supported by this meta-analysis. SDD may be useful in speci fic circumstances where a particular ICU or ICU population is found to have an excessive incidence of acquired infections. Any use of SDD sh ould include careful patient surveillance for the emergence of infecti on due to bacteria not covered by the prophylaxis regimen and due to a ntibiotic-resistant bacteria.