Topical antibiotics as a major contextual hazard toward bacteremia within selective digestive decontamination studies: a meta-analysis

BMC Infectious Diseases

Research Article

James C Hurley¹ 

[1] Associate Professor, Rural Health Academic Center, Melbourne Medical School, University of Melbourne, Melbourne, Australia;Physician and Head of General Medicine, Internal Medicine Service, Ballarat Health Services, 3353, Ballarat, Australia;Chairman, Infection Control Committees, St John of God Hospital and Ballarat Health Services, Ballarat, VIC, Australia;

关键词: Ventilator associated pneumonia;    Bacteremia;    Benchmarking;    Antibiotic prophylaxis;    Cross infection;    Caterpillar plots;   

DOI  :  10.1186/s12879-014-0714-x

 received in 2014-09-04, accepted in 2014-12-11,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundAmong methods for preventing pneumonia and possibly also bacteremia in intensive care unit (ICU) patients, Selective Digestive Decontamination (SDD) appears most effective within randomized concurrent controlled trials (RCCT’s) although more recent trials have been cluster randomized. However, of the SDD components, whether protocolized parenteral antibiotic prophylaxis (PPAP) is required, and whether the topical antibiotic actually presents a contextual hazard, remain unresolved. The objective here is to compare the bacteremia rates and patterns of isolates in SDD-RCCT’s versus the broader evidence base.MethodsBacteremia incidence proportion data were extracted from component (control and intervention) groups decanted from studies investigating antibiotic (SDD) or non-antibiotic methods of VAP prevention and summarized using random effects meta-analysis of study and group level data. A reference category of groups derived from purely observational studies without any prevention method under study provided a benchmark incidence.ResultsWithin SDD RCCTs, the mean bacteremia incidence among concurrent component groups not exposed to PPAP (27 control; 17.1%; 13.1-22.1% and 12 intervention groups; 16.2%; 9.1-27.3%) is double that of the benchmark bacteremia incidence derived from 39 benchmark groups (8.3; 6.8-10.2%) and also 20 control groups from studies of non-antibiotic methods (7.1%; 4.8 – 10.5). There is a selective increase in coagulase negative staphylococci (CNS) but not in Pseudomonas aeruginosa among bacteremia isolates within control groups of SDD-RCCT’s versus benchmark groups with data available.ConclusionsThe topical antibiotic component of SDD presents a major contextual hazard toward bacteremia against which the PPAP component partially mitigates.

【 授权许可】

CC BY   
© Hurley; licensee BioMed Central. 2014