Australian Regenerative Medicine Institute

The Role of Selective Digestive Tract Decontamination on Mortality and Respiratory Tract Infections: Methods

Twenty-one English-language studies of SDD prophylaxis” were initially identified and reviewed using a data extraction form previously described. These articles were obtained from a MEDLINE search as well as from review of the bibliographies of relevant original investigations and review articles. Prospectively delineated criteria for inclusion of a study into the metaanalysis were the following: publication in an English-language journal; patient selection for SDD administration via a prospective randomization protocol; use of patient mortality as an outcome measure; and sample sizes greater than ten per randomization group. Studies were excluded from analysis only if they used historical controls (four studies”) or if SDD administration was not performed randomly (one study). Table 1 summarizes the studies examined in this analysis. Of the 16 studies analyzed,” 14 were prospective randomized trials with 5 of these using placebo-blinded control groups (Table 1). Two studies used placebo-blinded crossover designs. A x2 analysis was used to compare hospital mortality rates and respiratory infection rates between the patients receiving SDD and the control patients. canadian neightbor pharmacy

Respiratory infections were divided into pneumonia and tracheobronchitis. For purposes of this analysis, only one episode of pneumonia or tracheobronchitis per patient was assessed to minimize the possibility of repeated measurements for the same respiratory infection due to inadequate initial treatment and relapse of that infection. Only nosocomial respiratory infections acquired during performance of the study protocols were analyzed. Risk differences (Pc—Pt) for rates of mortality, pneumonia, and tracheobronchitis were calculated between control patients (Pc) and SDD-treated patients (Pt) for individual studies as well as for the cumulative patient populations. All risk differences are expressed with their corresponding 95 percent confidence intervals. A positive risk difference suggests a benefit for the SDD regimen. All outcome rates are expressed as a fraction from 0.00 to 1.00 representing the fraction of outcomes for the examined group at risk. Statistical significance was defined as p<0.05.

Table 1—Prospective Studies of Selective Digestive Decontamination for Infection Prophylaxis

StudyReference Mortality Pneumonia T racheobronchitis StudyDesign StudyPopulation
Pc P. Pc Pt Pc Pt
29 15/84(17.9) 12/97(12.4) 8/84(9.5) 0/97(0.0) ID ID R,C,PB,SCt T,M,S
30 10/21(47.6) 13/25(52.0) ID ID ID ID R,C,PB,SC T,S
31 2/58(3.4) 3/56(5.4) 8/58(13.8) 1/56(1.8) ID ID R,C,SC s
32 21/125(16.8) 21/114(18.4) 8/125(6.4) 8/114(7.0) 20/125(16.0) 17/114(14.9) R,C,PB,SC T,M,S
33 5/15(33.3) 4/13(30.8) 11/15(73.3) 0/13(0.0) 3/15(20.0) 3/13(23.1) R,C,PB,MC T,M,S
34 32/170(18.8) 24/161(14.9) 45/170(26.5) 12/161(7.5) ID ID R,C,SC T,M,S
35 6/39(15.4) 2/17(11-8) 10/39(25.6) 0/17(0.0) 17/39(43.6) 1/17(5.9) R,C,SCR,C,SC T,M,ST,M,S
36 1/56(1.8) 0/51(0.0) 5/56(8.9) 1/51(2.0) ID ID R,C,SC S
37 46/101(45.5) 34/99(34.3) 46/101(45.5) 10/99(10.1) ID ID R,C,PB,SCt T,S
38 15/47(31.9) 14/49(28.6) ID ID ID ID R,C,SC T,S
39 7/27(25.9) 7/25(28.0) 21/27(77.8) 4/25(16.0) ID ID R,C,PB,SC T,S
40 28/52(53.3) 15/48(31.3) 26/52(50.0) 7/48(14.6) ID ID R,C,SC T,M,S
41 82/225(36.4) 88/220(40.0) 33/225(14.7) 26/220(11.8) 6/225(2.7) 3/220(1.4) R,C,PB,MC T,M,S
42 6/20(30.0) 5/19(26.3) 9/20(45.0) 1/19(5.3) 5/20(25.0) 3/19(15.8) R,C,SC T,N,S
43 13/50(26.0) 15/36(41.7) 6/50(12.0) 3/36(8.3) 5/50(10.0) 4/36(П.1) R,C,SC M
44 16/75(21.3) 11/75(14.7) 4/75(5.3) 3/75(4.0) 8/75(Ю.7) 1/75(1.3) R,C,SC T,M,S
Cumulativevalues 305/1165(26.2) 268/1105(24.3) 240/1097(21.9) 76/1031(7.4)| 64/549(П.7) 32/494 (6.5) §

Category: Respiratory Symptoms

Tags: acquired infections, gram-positive bacteria, pneumonia, respiratory infection, tracheobronchitis