Systematic Review

Intensive Care Medicine

, Volume 31, Issue 7, pp 898-910

First online:

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

  • Luciano SilvestriAffiliated withDepartment of Emergency, Unit of Anaesthesia and Intensive Care, Presidio Ospedaliero di Gorizia Email author 
  • , Hendrik K. F. van SaeneAffiliated withDepartment of Medical Microbiology, University of Liverpool
  • , Marco MilaneseAffiliated withDepartment of Emergency, Unit of Anaesthesia and Intensive Care, Presidio Ospedaliero di Gorizia
  • , Dario GregoriAffiliated withDepartment of Public Health and Microbiology, University of Turin

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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.

Keywords

Antibiotic prophylaxis Antifungal agents Carriage Selective decontamination