• Luciano Silvestri, Hendrik K F van Saene, Marco Milanese, and Dario Gregori.
• Department of Emergency, Unit of Anaesthesia and Intensive Care, Presidio Ospedaliero di Gorizia, Via Vittorio Veneto 171, 34170, Gorizia, Italy. lucianosilvestri@yahoo.it
• Intensive Care Med. 2005 Jul 1;31(7):898-910.

ObjectiveTo determine the impact of the antifungal component of selective decontamination of the digestive tract on fungal carriage, infection and fungaemia.DesignMeta-analysis of randomized controlled trials of selective decontamination of the digestive tract.Study SelectionData 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.MethodsThree 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 ResultsEnteral 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).ConclusionsAntifungals, 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.

16 keywords...

hide…