Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 1998 Apr 25;316(7140):1275-85.
doi: 10.1136/bmj.316.7140.1275.

Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials

R D'Amico  1 , S Pifferi, C Leonetti, V Torri, A Tinazzi, A Liberati
Affiliations
Meta-Analysis

Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials

R D'Amico et al. BMJ. .

Abstract

Objective: To determine whether antibiotic prophylaxis reduces respiratory tract infections and overall mortality in unselected critically ill adult patients.

Design: Meta-analysis of randomised controlled trials from 1984 and 1996 that compared different forms of antibiotic prophylaxis used to reduce respiratory tract infections and mortality with aggregate data and, in a subset of trials, data from individual patients.

Subjects: Unselected critically ill adult patients; 5727 patients for aggregate data meta-analysis, 4343 for confirmatory meta-analysis with data from individual patients.

Main outcome measures: Respiratory tract infections and total mortality.

Results: Two categories of eligible trials were defined: topical plus systemic antibiotics versus no treatment and topical preparation with or without a systemic antibiotic versus a systemic agent or placebo. Estimates from aggregate data meta-analysis of 16 trials (3361 patients) that tested combined treatment indicated a strong significant reduction in infection (odds ratio 0.35; 95% confidence interval 0.29 to 0.41) and total mortality (0.80; 0.69 to 0.93). With this treatment five and 23 patients would need to be treated to prevent one infection and one death, respectively. Similar analysis of 17 trials (2366 patients) that tested only topical antibiotics indicated a clear reduction in infection (0.56; 0.46 to 0.68) without a significant effect on total mortality (1.01; 0.84 to 1.22). Analysis of data from individual patients yielded similar results. No significant differences in treatment effect by major subgroups of patients emerged from the analyses.

Conclusions: This meta-analysis of 15 years of clinical research suggests that antibiotic prophylaxis with a combination of topical and systemic drugs can reduce respiratory tract infections and overall mortality in critically ill patients. This effect is significant and worth while, and it should be considered when practice guidelines are defined.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Meta-analysis of aggregate data. Effect of combination of topical and systemic antibiotics as prophylaxis for respiratory tract infections in patients in intensive care units
Figure 2
Figure 2
Meta-analysis of aggregate data. Effect of topical antibiotics as prophylaxis for respiratory tract infections in patients in intensive care units
Figure 3
Figure 3
Meta-analysis of aggregate data. Effect of combination of topical and systemic antibiotics on mortality in patients in intensive care units
Figure 4
Figure 4
Meta-analysis of aggregate data. Effect of topical antibiotics on mortality in patients in intensive care units
See this image and copyright information in PMC

Comment in

  • ACP J Club. 1998 Sep-Oct;129(2):31

References

    1. Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C. Nosocomial pneumonia and mortality among patients in intensive care unit. JAMA. 1996;275:866–869. - PubMed
    1. Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993;94:281–288. - PubMed
    1. 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 Med. 1984;10:185–192. - PubMed
    1. Vandenbroucke-Grauls CM, Vandenbroucke-Grauls JP. Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in intensive care unit. Lancet. 1991;338:859–862. - PubMed
    1. SDD Trialists’ Collaborative Group. Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract. BMJ. 1993;307:525–532. - PMC - PubMed

Publication types

MeSH terms

Substances