Antibiotic Prophylaxis to Reduce Respiratory Tract Infections and Mortality in Adults Receiving Intensive Care

Overview

Journal Cochrane Database Syst Rev

Publisher Wiley

Specialties General Medicine
Health Services

Date 2009 Oct 13

PMID 19821262

Citations 103

Authors

Alessandro Liberati

Roberto DAmico

Silvia Pifferi

Valter Torri

Luca Brazzi

Elena Parmelli

Affiliations

Soon will be listed here.

Abstract

Background: Pneumonia is an important cause of mortality in intensive care units (ICUs). The incidence of pneumonia in ICU patients ranges between 7% and 40%, and the crude mortality from ventilator-associated pneumonia may exceed 50%. Although not all deaths in patients with this form of pneumonia are directly attributable to pneumonia, it has been shown to contribute to mortality in ICUs independently of other factors that are also strongly associated with such deaths.

Objectives: To assess the effects of prophylactic antibiotic regimens, such as selective decontamination of the digestive tract (SDD) for the prevention of respiratory tract infections (RTIs) and overall mortality in adults receiving intensive care.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 1), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register; MEDLINE (January 1966 to March 2009); and EMBASE (January 1990 to March 2009).

Selection Criteria: Randomised controlled trials (RCTs) of antibiotic prophylaxis for RTIs and deaths among adult ICU patients.

Data Collection And Analysis: At least two review authors independently extracted data and assessed trial quality.

Main Results: We included 36 trials involving 6914 people. There was variation in the antibiotics used, patient characteristics and risk of RTIs and mortality in the control groups. In trials comparing a combination of topical and systemic antibiotics, there was a significant reduction in both RTIs (number of studies = 16, odds ratio (OR) 0.28, 95% confidence interval (CI) 0.20 to 0.38) and total mortality (number of studies = 17, OR 0.75, 95% CI 0.65 to 0.87) in the treated group. In trials comparing topical antimicrobials alone (or comparing topical plus systemic versus systemic alone) there was a significant reduction in RTIs (number of studies = 17, OR 0.44, 95% CI 0.31 to 0.63) but not in total mortality (number of studies = 19, OR 0.97, 95% CI 0.82 to 1.16) in the treated group.

Authors' Conclusions: A combination of topical and systemic prophylactic antibiotics reduces RTIs and overall mortality in adult patients receiving intensive care. Treatment based on the use of topical prophylaxis alone reduces respiratory infections but not mortality. The risk of resistance occurring as a negative consequence of antibiotic use was appropriately explored only in one trial which did not show any such effect.

Citing Articles

Structural Equation Modelling as a Proof-of-Concept Tool for Mediation Mechanisms Between Topical Antibiotic Prophylaxis and Six Types of Blood Stream Infection Among ICU Patients.

Hurley J Antibiotics (Basel). 2024; 13(11).

PMID: 39596789 PMC: 11591272. DOI: 10.3390/antibiotics13111096.

Estimating the herd effects of anti-microbial-based decontamination (ABD) interventions on intensive care unit (ICU) acquired bloodstream infections: a deductive meta-analysis.

Hurley J BMJ Open. 2024; 14(11):e092030.

PMID: 39572099 PMC: 11580273. DOI: 10.1136/bmjopen-2024-092030.

Selective Digestive Decontamination: A Comprehensive Approach to Reducing Nosocomial Infections and Antimicrobial Resistance in the ICU.

Martinez-Perez M, Fernandez-Fernandez R, Moron R, Nieto-Sanchez M, Yuste M, Diaz-Villamarin X J Clin Med. 2024; 13(21).

PMID: 39518621 PMC: 11546732. DOI: 10.3390/jcm13216482.

Visualizing and diagnosing spillover within randomized concurrent controlled trials through the application of diagnostic test assessment methods.

Hurley J BMC Med Res Methodol. 2024; 24(1):182.

PMID: 39152400 PMC: 11328391. DOI: 10.1186/s12874-024-02296-1.

The Relationship between Selective Digestive Decontamination and Nosocomial Infections in Patients Receiving Continuous Renal Replacement Therapy in ICUs: A Multicenter Study.

Vicente Arranz J, Sanchez-Ramirez C, Saavedra P, Rivero Perdomo Y, Lorenzo-Martin M, Blanco-Lopez J J Clin Med. 2024; 13(14).

PMID: 39064251 PMC: 11278040. DOI: 10.3390/jcm13144211.

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