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Selective decontamination of the digestive tract in critically ill children: systematic review and meta-analysis
Andy Petros1, Luciano Silvestri, Rachelle Booth
1Pediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trst, London, United Kingdom. petroa@gosh.nhs.uk
Insights
Selective decontamination of the digestive tract significantly reduced pneumonia in critically ill children. This intervention did not impact overall mortality rates in the analyzed pediatric studies.
Area of Science:
- Critical Care Medicine
- Pediatric Infectious Diseases
- Clinical Pharmacy
Background:
- Critically ill children are susceptible to infections, including pneumonia.
- Selective decontamination of the digestive tract (SDDT) is a strategy to prevent infections in intensive care settings.
Purpose of the Study:
- To evaluate the effectiveness of SDDT in reducing morbidity and mortality in critically ill children.
- To synthesize evidence from randomized controlled trials (RCTs) on SDDT in pediatric intensive care.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, EMBASE, Cochrane).
- Included RCTs compared SDDT (with or without parenteral antimicrobials) against placebo or standard care.
- Primary outcome was acquired pneumonia; secondary outcomes included infection rates and overall mortality, analyzed using random-effects modeling.
Main Results:
- Four RCTs with 335 pediatric patients were analyzed.
- SDDT significantly reduced pneumonia incidence (2.9% vs. 9.7%; OR 0.31; P = .027).
- No significant difference in overall mortality (7.6% vs. 6.7%; OR 1.18; P = .70) or infection rates (18.5% vs. 43.6%; OR 0.34; P = .25) was observed.
Conclusions:
- SDDT demonstrates a significant benefit in preventing pneumonia in critically ill children.
- Further research may be needed to clarify its impact on overall mortality and infection rates in this population.
Objective:
We examined the impact of selective decontamination of the digestive tract on morbidity and mortality in critically ill children.
Data Sources:
We searched MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, and previous meta-analyses.
Study Selection:
We included all randomized controlled trials comparing administration of enteral antimicrobials in selective decontamination of the digestive tract with or without a parenteral component with placebo or standard therapy used in the controls.
Data Extraction:
The primary end point was the number of acquired pneumonias. Secondary end points were number of infections and overall mortality. Odds ratios were pooled with the random effect model.
Data Synthesis:
Four randomized controlled trials including 335 patients were identified. Pneumonia was diagnosed in five of 170 patients (2.9%) for selective decontamination of the digestive tract and 16 of 165 patients (9.7%) for controls (odds ratio 0.31; 95% confidence interval 0.11-0.87; p = .027). Overall mortality for selective decontamination of the digestive tract was 13 of 170 (7.6%) vs. control, 11 of 165 (6.7%) (odds ratio 1.18; 95% confidence interval 0.50-2.76; p = .70). In three studies (n = 109), infection occurred in ten of 54 (18.5%) patients on selective decontamination of the digestive tract and 24 of 55 (43.6%) in the controls (odds ratio 0.34; 95% confidence interval 0.05-2.18; p = .25).
Conclusions:
In the four available pediatric randomized controlled trials, selective decontamination of the digestive tract significantly reduced the number of children who developed pneumonia.
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