Topical antibiotics as a major contextual hazard toward bacteremia within selective digestive decontamination studies: a meta-analysis

Hurley, James C

doi:10.1186/s12879-014-0714-x

Table 1 Characteristics of studies ^a

From: Topical antibiotics as a major contextual hazard toward bacteremia within selective digestive decontamination studies: a meta-analysis

	Observational studies	Groups of interventional studies of VAP prevention
		Non-antibiotic methods		Antibiotic (SDD)
		Gastric	Airway or oral	Non-concurrent	RCCT	RCCT -Duplex
Study characteristics
Sources [see Additional file 1]	Table S1	Table S2	Table S2	Table S3	Table S4	Table S5
Number of studies	36	13	9	16	28	12
Non-SR	29	5	3	7	2	0
EU origin^b	18	6	8	8	20	8
MV for >48 hours for <90%^c	12	2	1	5	5	0
Trauma ICUs^d	2	2	1	1	5	3
CDC^e	23	4	4	6	14	5
Study publication year (range)	1987-2013	1989-2014	1993-2013	1987-2011	1988-2007	1990-2002
Group characteristics
Numbers of patients per study group; median (IQR)^f	302; 153-846	74; 39-156	132; 76-190	104; 48-161	54; 39-110	43; 38-58
VAP incidence per 100 patients;
mean; 95% CI (number of groups)
Observational	22.2%; 17.8–27.3% (31)^g	NA		NA	NA
Control	NA	21.9%; 14.4-31.7% (12) ^h	17.1%; 8.9-30.4% (8)^h	36.8%; 16.7-62.8% (10)ⁱ	31.2%; 21.7-42.5% (24)ⁱ	22.7%; 14.4-34.2% (11)ⁱ
Intervention	NA	14.0%; 9.0-21.2% (13) ^h	11.7%; 6.0-21.3% (9)^h	13.1%; 6.2 – 25.5 (13)^j	12.4%; 8.9-17.0% (27)^j	7.1%; 3.5-13.8% (10)^j
Bacteremia incidence per 100 patients;
mean; 95% CI (number of groups)
Observational	8.3%; 6.8–10.2% (39)^k	NA	NA	NA	NA	NA
Control	NA	7.1%; 4.1-12.2% (12)^l,m,n	7.1%; 3.5-14.1% (8)^l,m,n	12.0%; 6.9-20.2% (10)^o	17.1%; 13.1-22.1% (27)^o,n	NA
Control - duplex						5.7%; 3.1-10.8% (13)^o
Intervention – non-antibiotic	NA	5.8%; 3.3-9.9% (13)^l	4.9%; 2.2-10.4% (9)^l
Intervention – topical antibiotic alone				12.8%; 7.8-20.5% (3)^p	16.2%; 9.1-27.3% (12)^p	NA
Intervention – topical and parenteral antibiotic				6.3%; 3.9-10.1% (10)^p	8.9%; 5.8-13.3% (18)^p	7.7%; 4.8-12.2% (13)^p
Bacteremia microbiology per 100 isolates^q
mean; 95% CI (number of groups)
• Coagulase negative Staphylococci
Observational	16.2%; 12.1-21.2% (16)^q,r	NA	NA	NA	NA	NA
Control	NA	NA	NA	3.7%; 0.2-39.3% (1)^q,s	32.6%; 23.0-44.0% (5)^q,s	27.5%; 12.1-50.9% (5)^q,s
• Pseudomonas aeruginosa
Observational	7.7%; 6.2–9.4% (16)^q,t	NA	NA	NA	NA	NA
Control	NA	NA	NA	7.7%; 1.1-39.1% (1)^q,u	5.6%; 2.7-11.3% (7)^q,u	10.6%; 2.7-34.2% (3)^q,u

^aAbbreviations; ICU, Intensive care unit; MV; EU, European Union; Mechanical ventilation; NA not applicable; RCCT randomized concurrent controlled trials.
^bOriginating from a member state of the EU as at 2010 or Switzerland or Norway.
^cStudies for which less than 90% of patients were reported to receive more than 48 hours of mechanical ventilation.
^dTrauma ICU defined as an ICU with >50% of patient admissions for trauma.
^eStudies that indicated that CDC criteria were used to define bacteremia.
^fData is median and inter-quartile range (IQR).
^gAs derived in Figure S1 (see Additional file 2).
^hAs derived in Figure S2 (see Additional file 2).
ⁱAs derived in Figure S3 (see Additional file 2).
^jAs derived in Figure S4 (see Additional file 2).
^kAs derived in Figure 4.
^lAs derived in Figure 5.
^mThe bacteremia incidence on inclusion of all concurrent control groups from studies of non-antibiotic methods is 7.1; 4.8-10.5 (n = 20).
ⁿSensitivity test one. The bacteremia incidence on inclusion of all concurrent control groups not receiving PPAP from studies of non-antibiotic and antibiotic methods is 11.9; 9.3-15.3 (n = 47).
^oAs derived in Figure 6.
^pAs derived in Figure 7.
^qSee Table S6 (Additional file 1).
^rAs derived in Figure S5 (see Additional file 2).
^sAs derived in Figure S6 (see Additional file 2).
^tAs derived in Figure S7 (see Additional file 2).
^uAs derived in Figure S8 (see Additional file 2).

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