EFFECTIVENESS OF ANTIBIOTIC-PROPHYLAXIS IN CRITICALLY ILL ADULT PATIENTS - SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

Objective: To determine whether antibiotic prophylaxis reduces respira tory tract infections and overall mortality in unselected critically i ll adult patients. Design: Meta-analysis of randomised controlled tria ls from 1984 and 1996 that compared different forms of antibiotic prop hylaxis used to reduce respiratory tract infections and mortality with aggregate data and, in a subset of trials, data from individual patie nts. Subjects: Unselected critically ill adult patients; 5727 patients for aggregate data meta-analysis, 4343 for confirmatory meta-analysis with data from individual patients. Main outcome measures: Respirator y tract infections and total mortality. Results: Two categories of eli gible trials were defined: topical plus systemic antibiotics versus no treatment and topical preparation with or without a systemic antibiot ic versus a systemic agent or placebo, Estimates from aggregate data m eta-analysis of 16 trials (3361 patients) that tested combined treatme nt indicated a strong significant reduction in infection (odds ratio 0 .35; 95% confidence interval 0.29 to 0.41) and total mortality (0.80; 0.69 to 0.93). With this treatment five and 23 patients would need to be treated to prevent one infection and one death, respectively Simila r analysis of 17 trials (2366 patients) that tested only topical antib iotics indicated a clear reduction in infection (0.56; 0.46 to 0.68) w ithout a significant effect on total mortality (1.01; 0.84 to 1.22). A nalysis of data from individual patients yielded similar results. No s ignificant differences in treatment effect by major subgroups of patie nts emerged from the analyses. Conclusions: This meta-analysis of 15 y ears of clinical research suggests that antibiotic prophylaxis with a combination of topical and systemic drugs can reduce respiratory tract infections and overall mortality in critically ill patients. This eff ect is significant and worth while, and it should be considered when p ractice guidelines are defined.