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Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care

  1. Roberto D'Amico1,*,
  2. Silvia Pifferi2,
  3. Valter Torri3,
  4. Luca Brazzi4,
  5. Elena Parmelli5,
  6. Alessandro Liberati6,†

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 13 MAR 2009

DOI: 10.1002/14651858.CD000022.pub3


How to Cite

D'Amico R, Pifferi S, Torri V, Brazzi L, Parmelli E, Liberati A. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD000022. DOI: 10.1002/14651858.CD000022.pub3.

Author Information

  1. 1

    University of Modena and Reggio Emilia, Statistics Unit, Department of clinical and diagnostic medicine and public health, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy

  2. 2

    Policlinico San Matteo, Pavia, Milano, Italy

  3. 3

    Mario Negri Institute, Laboratorio di Epidemiologia Clinica, Milano, Milano, Italy

  4. 4

    Università degli Studi di Sassari, Dipartimento di Scienze Chirurgiche, Microchirurgiche e Mediche, Sassari, Italy

  5. 5

    University of Modena and Reggio Emilia, Department of Oncology, Hematology and Respiratory Diseases, Modena, Italy

  6. 6

    Mario Negri Institute for Pharmacological Research, Italian Cochrane Centre, Milan, Italy

  1. Deceased

*Roberto D'Amico, Statistics Unit, Department of clinical and diagnostic medicine and public health, University of Modena and Reggio Emilia, Modena, Italy, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41121, Italy. roberto.damico@unimore.it.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 7 OCT 2009

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Abele-Horn 1997 {published data only}
  • Abele-Horn M, Dauber A, Bauernfeind A, Russwurm W, Seyfarth-Metzger I, Gleich P, et al. Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD). Intensive Care Medicine 1997;23(2):187-95.
Aerdts 1991 {published and unpublished data}
  • Aerdts SJA, van Dalen R, Clasener HAL, Festen J, van Lier HJJ, Vollaard EJ. Antibiotic prophylaxis of respiratory tract infection in mechanically ventilated patients. Chest 1991;100(3):783-91.
Bergmans 2001 {published data only}
  • Bergmans DCJJ, Bonten MJM, Gailard CA, Paling JC, van der Geest S, van Tiel FH, et al. Prevention of ventilator-associated pneumonia by oral decontamination: a prospective randomized, double blind, placebo controlled study. American Journal of Respiratory and Critical Care Medicine 2001;164(3):382-8.
Blair 1991 {published and unpublished data}
  • Blair P, Rowlands BJ, Lowry K, Webb H, Amstrong P, Smilie J. Selective decontamination of the digestive tract: a stratified, randomized, prospective study in a mixed intensive care unit. Surgery 1991;110(2):303-10.
Boland 1991 {published and unpublished data}
  • Boland JP, Sadler DL, Stewart W, Wood DJ, Zerick W, Snodgrass KR. Reduction of nosocomial respiratory tract infections in the multiple trauma patients requiring mechanical ventilation by selective parenteral and enteral antisepsis regimen (SPEAR) in the intensive care. XVII Congress of Chemotherapy. 1991.
Brun-Buisson 1989 {published and unpublished data}
  • Brun-Buisson C, Legrand P, Rauss A, Richard C, Montravers F, Besbes M, et al. Intestinal decontamination for control of nosocomial multiresistant Gram-negative bacilli. Annals of Internal Medicine 1989;110(11):873-81.
Camus 2005 {published data only}
  • Camus C, Bellissant E, Sebille W, Perrotin D, Garo B, Legras A, et al. Prevention of acquired infections in intubated patients with combination of two decontaminations regimens. Critical Care Medicine 2005;33(2):307-14.
Cerra 1992 {published and unpublished data}
  • Cerra FB, Maddaus MA, Dunn DL, Wells CL, Konstantinides NN, Lehmann SL, et al. Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care unit patients. Archives of Surgery 1992;127(2):163-9.
Cockerill 1992 {published and unpublished data}
  • Cockerill FR III, Muller SR, Anhalt JP, Marsh HM, Farnell MB, Mucha P, et al. Prevention of infection in critically ill patients by selective decontamination of the digestive tract. Annals of Internal Medicine 1992;117(7):545-53.
de Jonge 2003 {published data only}
  • de Jonge E, Schultz JM, Spanjaard L, Bossuyt PMM, Vroom MB, Dankert J, et al. Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 2003;362(9389):1011-6.
Ferrer 1994 {published and unpublished data}
  • Ferrer M, Torres A, Gonzàles J, de la Bellacasa JP, El-Ebiary M, Roca M, et al. Utility of selective digestive decontamination in mechanically ventilated patients. Annals of Internal Medicine 1994;120:389-95.
Finch 1991 {published and unpublished data}
  • Finch RG, Tomlinson P, Holliday M, Sole K, Stack C, Rocker G. Selective decontamination of the digestive tract (SDD) in the prevention of secondary sepsis in a medical/surgical intensive care unit. XVII International Congress Chemotherapy. 1991.
Gastinne 1992 {published and unpublished data}
  • Gastinne H, Wolff M, Delatour F, Faurisson F, Chevret S. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. New England Journal of Medicine 1992;326:594-9.
Gaussorgues 1991 {published and unpublished data}
  • Gaussorgues P, Salord F, Sirodot M, Tigaud S, Cagnin S, Gerard M, et al. [Efficacité de la décontamination digestive sur la survenue des bactériémies nosocomiales chez les patients sous ventilation mécanique et recevant des betamimétiques]. Reanimation, Soins Intensifs, Medicine d'Urgence 1991;7:169-74.
Georges 1994 {published data only}
  • Georges B, Mazerolles M, Decun JF, Rouge P, Pomies S, Cougot P, et al. [Décontamination digestive sélective résultats d'une ètude chez le polytraumatisé]. Reanimation d'Urgence 1994;3:621-7.
Hammond 1992 {published and unpublished data}
Jacobs 1992 {published and unpublished data}
  • Jacobs S, Foweraker JE, Roberts SE. Effectiveness of selective decontamination of the digestive tract (SDD) in an ICU with a policy encouraging a low gastric pH. Clinical Intensive Care 1992;3:52-8.
Kerver 1988 {published and unpublished data}
  • Kerver AJH, Rommes JH, Mevissen-Verhage EAE, Hulstaert PF, Vos A, Verhoef J, et al. Prevention of colonization and infection in critically ill patients: A prospective randomized study. Critical Care Medicine 1988;16:1087.
Korinek 1993 {published and unpublished data}
  • Korinek AM, Laisne MJ, Raskine L, Deroin V, Sanson-Lepors MJ. Selective decontamination of the digestive tract in neurosurgical care units patients: a double blind, randomized, placebo-controlled study. Critical Care Medicine 1993;21:1466-73.
Krueger 2002 {published data only}
  • Krueger WA, Lenhart FP, Neeser G, Ruckdeschel G, Schreckhase H, Eissner HJ, et al. Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions and mortality in critically ill surgical patients. American Journal of Respiratory and Critical Care Medicine 2002;166:1029-37.
Laggner 1994 {published and unpublished data}
  • Laggner AN, Tryba M, Georgopoulos A, Lenz K, Grimm G, Graninger W, et al. Oropharyngeal decontamination with gentamicin for long-term ventilated patients on stress ulcer prophylaxis with sucralfate?. Wiener Klinische Wochenschrift 1994;106:15-9.
Lingnau 1997 {published and unpublished data}
  • Lingnau W, Berger J, Javorsky F, Lejeune P, Mutz N, Benzer H. Selective intestinal decontamination in multiple trauma patients: prospective, controlled trials. Journal of Trauma 1997;42:687-94.
Lingnau 1997b {published and unpublished data}
  • Lingnau W, Berger J, Javorsky F, Lejeune P, Mutz N, Benzer H. Selective intestinal decontamination in multiple trauma patients: prospective, controlled trials. Journal of Trauma 1997;42:687-94.
Palomar 1997 {published and unpublished data}
  • Palomar M, Alvarez-Lerma F, Jorda R, Bermejo B. Prevention of nosocomial infection in mechanically ventilated patients: Selective digestive decontamination versus sucralfate. Clinical Intensive Care 1997;8:228-35.
Pneumatikos 2002 {published data only}
  • Pneumatikos I, Koulouras V, Nathanail C, Goe D, Nakos G. Selective decontamination of subgloottic area in mechanically ventilated patients with multiple trauma. Intensive Care Medicine 2002;28:432-7.
Pugin 1991 {published and unpublished data}
Quinio 1995 {published and unpublished data}
  • Quinio B, Albanèse J, Bues-Charbit M, Viviand X, Martin C. Selective Decontamination of the digestive tract in multiple trauma patients: prospective, double blind, randomised, placebo-controlled study. Chest 1996;109:765-72.
Rocha 1992 {published and unpublished data}
  • Rocha LA, Martin MJ, Pita S, Paz J, Seco C, Margusino L, et al. Prevention of nosocomial infection in critically ill patients by selective decontamination of digestive tract. Intensive Care Medicine 1992;18:398-404.
Rodriguez-Rolda 1990 {published and unpublished data}
  • Rodrìguez-Roldàn JM, Altuna-Cuesta A, Lòpez A, Carrillo A, Garcia J, Leòn J, et al. Prevention of nosocomial lung infection in ventilated patients:use of an antimicrobial pharyngeal nonabsorbable paste. Critical Care Medicine 1990;18:1239-42.
Sanchez-Garcia 1992 {published and unpublished data}
  • Sanchez-Garcia M, Cambronero JA, Lopez J, Cerda E, Rubio J, et al. Effectiveness and cost of selective decontamination of the digestive tract (SDD) in critically ill intubated patients. A randomized, double blind, placebo-controlled, multicentric trial. American Journal of Respiratory and Critical Care Medicine 1998;158:908-16.
Stoutenbeek 1996 {published data only}
  • Stoutenbeek CP, Van Saene HKF, Miranda D R, Zandstra DF. The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Medicine 1984;10:185-92.
Stoutenbeek 2007 {published data only}
  • Stoutenbeek CP, Van Saene HKF, Little RA, Whitehead A. The effect of selective decontamination on the digestive tract on mortality in multiple trauma patients: a multicentre randomized controlled trial. Intensive Care Medicine 2007;33:261-70.
Ulrich 1989 {published and unpublished data}
  • Ulrich C, Harinck-deWeerd JE, Bakker NC, Jacz K, Doornbos L, de Ridder VA. Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intensive Care Medicine 1989;15:424-31.
Unertl 1987 {published and unpublished data}
  • Unertl K, Ruckdeschel G, Selbmann HK, Jensen U, Forst H, Lenhart FP, et al. Prevention of colonization and respiratory infections in long term ventilated patients by local antimicrobial prophylaxis. Intensive Care Medicine 1987;13:106-13.
Verwaest 1997 {published and unpublished data}
  • Verwaest C, Verhaegen J, Ferdinande P, Schets M, Van der Berghe G, Verbist L, et al. Randomized, controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multidisciplinary intensive care unit. Critical Care Medicine 1997;25:63-71.
Wiener 1995 {published data only}
  • Wiener J, Itokazu G, Nothan C, Kabins SA, Weinstein RA. A randomized, double-blind, placebo-controlled trial of selective digestive decontamination in a medical-surgical intensive care unit. Clinical Infectious Diseases 1995;20:861-7.
Winter 1992 {published and unpublished data}
  • Winter R, Humphreys H, Pick A, MacGowan AP, Willatts SM, Speller DCE. A controlled trials of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection. Journal of Antimicrobial Chemotherapy 1992;30:73-87.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Arnow 1996 {published data only}
  • Arnow PM, Carandanq GC, Irwin ME. Randomized controlled trial of selective bowel decontamination for prevention of infections following liver transplantation. Clinical Infectious Diseases 1996;22:997-1003.
Barret 2001 {published data only}
Bion 1994 {published data only}
  • Bion JF, Badger I, Crosby HA, Hutchings P, Kong KL, Baker J, et al. Selective decontamination of the digestive tract reduces Gram-negative pulmonary colonization but not systemic endotoxemia in patients undergoing elective liver transplantation. Critical Care Medicine 1994;22:40-9.
Bouter 2002 {published data only}
  • Bouter H, Schippers EF, Luelmo SAC, Verteegh MIM, et al. No effect of preoperative selective gut decontamination on endotoxemia and cytokine activation during cardiopulmonary bypass: A randomized, placebo controlled study. Critical Care Medicine 2002;30:38-43.
de la Cal 2005 {published data only}
  • de la Cal MA, Cerdà E, Garcia-Hierro P, et al. Survival benefit in critically hill burned patients receiving selective decontamination of the digestive tract. A randomized, placebo-controlled, double-blind trial. Annals of Internal Medicine 1992;117:545-53.
de Smet 2009 {published data only}
Flaherty 1990 {published data only}
  • Flaherty J, Nathan C, Kabins SA, Weinstein RA. Pilot trial of selective decontamination for prevention of bacterial infection in an intensive care unit. Journal of Infectious Diseases 1990;162:1393-7.
Garbino 2002 {published data only}
  • Garbino J, Lew DP, Romand JA, Hogonnet S, Auckenthaler R, Pittet D. Prevention of severe candida infections in nonneutropenic high risk, crically ill patients: a randomized, double blinded, placebo controlled trial in patients treated by severe digestive decontamination. Intensive Care Medicine 2002;28:1708-17.
Hellinger 2002 {published data only}
  • Hellinger WC, Yao JD, Alvarez S, Blair JE, et al. A randomized, prospective, double blinded evaluation of selective bowel decontamination in liver transplantation. Transplantation 2002;73:1904-9.
Hunefeld 1989 {published and unpublished data}
  • Hunefeldt G. [Klinische Studie zur selectiven Darmdekolonisation bei 204 langzeitbeatmeten abdominal und unfallchirurgischen Intensivpatienten]. Anaesthesiologie und Reanimation 1989;14:131-53.
Jacobs 1995 {unpublished data only}
  • Jacobs S, Zuleika M. no title. provided by the authors.
Lenhart 1994 {published data only}
  • Lenhart FP, Unertl K, Neeser G, Ruckdeschel G, Eckart J, Peter K. Selective decontamination and sucralfate for prevention of acquired infections in intensive care. 17th International Congress Chemotherapy, Vienna 1994 (K101). 1994.
Lipman 1994 {published and unpublished data}
  • Lipman J, Klugman K, Luyt D, Kraus P, Litmanovitch M, Johnson D, et al. Unique trial design shows SDD to decrease and alter colonization of upper respiractory tract in a multidisciplinary ICU. Critical Care Medicine 1994;22:1.
Luiten 1995 {published data only}
Martinez 1994 {published data only}
  • Martinez PAE, Bru M, Jara P, Ruiz J, Sanmiguel MT, Garcia PT. Does cefotaxime prevent early pneumonia in trauma patients receiving pharyngeal decontamination?. Medicina Intensiva 1994;18:245-9.
Martinez-Pellus 1993 {published data only}
  • Martinez-Pellus AE, Merino P, Bru M, Coneyero R, Seller G, Munoz C, et al. Can selective digestive decontamination avoid the endotoxemia and cytokine activation promoted by cardiopulmonary bypass?. Critical Care Medicine 1993;2:1684-91.
Nardi 2001 {published data only}
  • Nardi G, Di Silvestre A, De Monte A, Massarutti D, Proietti A, Grazia Troncon M, et al. Reduction in gram positive pneumonia and antibiotic consumption following the use of a SDD protocol including nasal nad oral mupirocin. European Journal of Emergency Medicine 2001;8:203-14.
Rayes 2002 {published data only}
  • Rayes N, Seehofer D, Hansen S, Boucsein K, et al. Early enteral supply of lactobacillus and fiber versus selective bowel decontamination: a controlled trial in liver transplant recipients. Transplatation 2002;74:123-8.
Rolando 1996 {published and unpublished data}
  • Rolando N, Wade J, Stangou A, Gimson AE, Wendon J, Philpott-Howard J, et al. Prospective study comparing the efficacy of prophylactic parenteral antimicrobials, with or without enteral decontamination, in patients with acute liver failure. Liver Transplantation and Surgery 1996;2:8-13.
Ruza 1998 {published data only}
  • Ruza F, Alvarado F, Herruzo R, Delgado MA, García S, Dorao P, et al. Prevention of nosocomial infection in a pediatric intensive care unit (PICU) through the use of selective digestive decontamination. European Journal of Epidemiology 1998;14:719-27.
Schardey 1997 {published and unpublished data}
  • Schardey HM, Joosten U, Finke U, Stanbach KH, Schauer R, Heiss A, et al. The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective double-blind, randomized and placebo-controlled clinical multicenter trial. Annals of Surgery 1997;225:172-80.
Smith 1993 {published data only}
  • Smith SD, Jackson RJ, Hannakan CJ, Wadowsky RM, Tzakis AG, Rowe MI, et al. Selective decontamination in pediatric liver transplant. A randomized prospective study. Transplantation 1993;55:1306-9.
Stoutenbeek 2 {unpublished data only}
  • Stoutenbeek CP, Van Saene HKF, Little RA, Whitehead A. The effect of selective decontamination of the digestive tratct on mortality in multiple trauma patients.. Contact with authors.
Tetteroo 1990 {published and unpublished data}
  • Tetteroo GWM, Wagenvoort JHT, Castelei A, Tilanus HW, Ince C, Bruining HA. Selective decontamination to reduce gram-negative colonisation and infections after oesophageal resection. Lancet 1990;335:704-7.
Zobel 1991 {published data only}
  • Zobel G, Kutting M, Grubbauer HM, Semmelrock HJ, Thiel W. Reduction of colonization and infection rate during pediatric intensive care by selective decontamination of digestive tract. CritIical Care Medicine 1991;19:1242-6.
Zwaveling 2002 {published data only}
  • Zweveling JH, Maring JK, Klompmaker IJ, Haagsma EB Bottema JT, Laseur M, et al. Selective decontamination of the digestive tract to prevent postoperative infection: a randomized placebo-controlled trial in liver transplant patients. Critical Care Medicine 2002;30(6):1204-9.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Chevret 1996
  • Chevret S, Hemmer M, Carlet J, Langer M. Incidence and risk factors of pneumonia acquired in intensive care units. Results from a multicenter prospective study on 996 patients. European Cooperative Group on Nosocomial Pneumonia. JAMA 1996;275(11):866-9.
Collard 2003
Fagon 1996
Heyland 1994
Higgins 2008
  • Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.0. The Cochrane Collaboration, 2008.
Hurley 1995
Kollef 1994
Lefebvre 2008
  • Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JP, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Chichester, UK: Wiley, 2008.
Liberati 2001
Nathens 1999
Redman 2001
  • Redman R, Ludington E. Analysis of respiratory and non-respiratory infections in published trials of selective digestive decontamination. Intensive Care Medicine (14th Annual Congress of the European Society of Intensive Care Medicine 2001). 2001, issue Suppl 2:285.
Silvestri 2007
  • Silvestri L, van Saene HKF, et al. Selective decontamination of the digestive tract reduces bacterial bloodstreem infection and mortality in critically ill patients. Systematic review of randomized controlled trials. Journal of Hospital Infection 2007;65:187-203.
Stoutenbeek 1994
  • Stoutenbeek CP, Van Saene HKF, Miranda DR, Zandstra DF. The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Medicine 1994;10:185-92.
van Nieuwenhove 2001
  • van Nieuwenhoven CA, Buskens E, van Tiel FH, Bonten MJ. Reletionship between methodological trial quality and the effects of selective digestive decontamination on pneumonia and mortality in critically ill patients. JAMA 2001;286:335-40.
Vanderbrouk-Gra 1991
  • Vanderbrouk-Grauls CM, Vanderbrouke-Grauls JP. Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in intensive care unit. Lancet 1991;338:859-62.

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
D'Amico 1998
  • D'Amico R, Pifferi S, Leonetti C, Torri V, Tinazzi A, Liberati A, et al. Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials. BMJ 1998;316:1275-85.
Liberati 1997
Liberati 2002
  • Liberati A, D'Amico R, Pifferi S, Leonetti C, Torri V, Brazzi L, et al. Antibiotics for preventing respiratory tract infections in adults receiving intensive care. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD000022.pub2]
Liberati 2004
  • Liberati A, D'Amico R, Pifferi, Torri V, Brazzi L. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD000022.pub2]
SDD Group 1993