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

Seven studies (Table 2) examining 1,306 patients provided bacteriologic data for those patients with acquired pneumonia. The incidence of acquired pneumonia due to Gram-negative bacteria in the SDD-treated group (rate=0.019) was significantly less than that in the control group (rate=0.138, p<0.0001). The occurrence of acquired pneumonia due to Gram-positive bacteria was similar between SDD-treated (rate=0.033) and control patients (rate=0.033, p=0.933).
Seven studies reported information on the occurrence of acquired tracheobronchitis (Table 1) in individual patients. Buy inhalers online in detail These studies yielded 1,043 patients for analysis of which 549 (52.6 percent) were in the control group and 494 (47.4 percent) were in the SDD-treated group. Sixty-four control patients developed at least one episode of acquired tracheobronchitis (rate=0.117), while 32 SDD-treated patients developed at least one episode of tracheobronchitis (rate=0.065, p=0.004).

The risk difference for acquired tracheobronchitis was 0.052 (95 percent confidence interval of 0.017 to 0.087). Risk differences for the individual studies and the cumulative population, along with their corresponding 95 percent confidence intervals, are shown in Figure 3. Total number of acquired infections occurring during the study protocols could be obtained from all but three investigations. These studies yielded 2,151 patients for analysis, of which 1,103 (51.3 percent) were in the control group and 1,048 (48.7 percent) were in the SDD-treated group. There were 227 Gram-positive infections in the control group (rate=0.206), while 179 Gram-positive infections occurred in the SDD-treated patients (rate=0.171, p=0.038). Three hundred ninety-two Gram-negative infections developed in the control group (rate=0.355), while 91 Gram-negative infections occurred in the SDD-treated group (rate=0.087, p<0.0001). Only six studies reported on mixed bacterial infections’’’ with 1,128 patients available for analysis (589 control patients, 539 SDD-treated patients). There were 48 mixed bacterial infections in the control group (rate=0.081) compared with 12 in the SDD-treated group (rate=0.022, p<0.0001).

Table 2—Prophylaxis Regimen and Etiology of Pneumonia

StudyReference Decontamination Regimen Gram-PositiveBacteria Gram-NegativeBacteria Comments
Oropharyngeal Gastric Systemic Pc Pt Pc Pt
29 T,P,A 1/84 0/97 7/84 0/97
30 Nor,Nys
31 T,P,A T,P,A С 2/58 1/56 6t/58 0/56 Includes mixed infectionst
32 T.P.A T,P,A Ct Given to both groupst
33 T or Nel,P,A 2/15 0/13 9/15 0/13
34 T,P,A T,P,A С 7/170 1/161 23t/170 3t/161 Includes mixed infection t
35 Nor,P,A Nor,P,A с
36 G,P,Nys G,P,Nys 2/56 1/51 3/56 0/51
37 T,P,A T.P.A ct Given to both groupst
38 T,P,A T,P,A с
39 Neo,P,V
40 Nor,P,A Nor,P,A Tri 2/52 3/48 23t/52 3t/48 Includes mixed infectionst
41 T,P,A T,P,A 6/225 15/220 20t/225 6t/220 Includes mixed infectionst
42 G,P,A G,P
43 Neo,P,NA
44 G.P.Nys G,P,Nys С
Cumulativeresults 22/660(3.3) 21/646(3.3) 91/660(13.8) 12/646(1.9)1

Figure-3

Figure 3. Acquired tracheobronchitis risk differences and 95 percent confidence intervals for individual studies and the cumulative study population (lowermost point). Study risk differences follow the order presented in Table 1 starting with reference 32 at the top.

This entry was posted in Respiratory Symptoms and tagged acquired infections, gram-positive bacteria, pneumonia, respiratory infection, tracheobronchitis.