ICU-acquired candidemia within selective digestive decontamination studies: a meta-analysis

Area of Science:

• Infectious Diseases
• Intensive Care Medicine
• Antimicrobial Stewardship

Background:

• Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection prevention strategies in intensive care units (ICUs).
• These protocols often involve topical antibiotics (TA) and protocolized antifungal prophylaxis (PAFP).
• The independent and combined effects of SDD/SOD constituents on ICU-acquired candidemia require clarification.

Purpose of the Study:

• To quantify the direct and indirect (contextual) effects of topical antibiotic (TA) and protocolized antifungal prophylaxis (PAFP) within SDD/SOD protocols on ICU-acquired candidemia.
• To establish a benchmark candidemia incidence from observational studies for comparison.
• To analyze the impact of TA and PAFP on candidemia incidence using regression models.

Main Methods:

• Systematic review and meta-analysis of ICU candidemia incidence studies.
• Extraction of candidemia incidence data from control and intervention groups of studies investigating SDD/SOD.
• Utilized generalized estimating equation (GEE) models for statistical analysis, with observational study data serving as an external benchmark.

Main Results:

• Candidemia incidence in concurrent SDD/SOD groups was higher than the benchmark incidence from observational studies.
• The topical antibiotic (TA) component of SDD/SOD demonstrated significant direct and indirect contextual effects on candidemia incidence.
• These effects remained significant after adjusting for publication year, candidemia risk factors, and PAFP use.

Conclusions:

• The topical antibiotic (TA) constituent of SDD/SOD is associated with a contextual effect on candidemia incidence comparable to conventional risk factors.
• Protocolized antifungal prophylaxis (PAFP) partially mitigates the increased candidemia risk associated with TA.
• The contextual effect of TA on candidemia incidence may not be apparent when examining individual SDD/SOD studies in isolation.