Table 2 Characteristics of included randomized controlled trials on topical decontamination by antibiotics

J Klastersky et al. 1974 [58]

Belgium

43/42

Gentamicin (S)

Normal saline (S)

Trachea

3 times/d

VAP^† Mortality All ICU^§-acquired infections

0.38; 0.17 to 0.86 1.36; 0.89 to 2.07 0.43; 0.16 to 1.14

Neurosurgical ICU^§

K Unertl et al.^| 1987 [59]

Germany

19/20

Polymyxin B+ Gentamicin (S) Amphotericin B (Su)

No antimicrobial prophylaxis

S applied orally, nasally and enterally; Su in the oropharynx^¶ (only T group)

4 times/d

VAP^† Mortality

0.12; 0.02 to 0.84 0.91; 0.43 to 1.92

Multidisciplinary ICU^§

C Brun Buisson** et al. 1989 [60]

France

36/50

Disinfection ^††+ Polymyxin E+ Neomycin+ Nalidixic acid (S)

Disinfection^††

Disinfection^†† of oropharynx^¶; S applied orally and enterally

Disinfection^†† 3 times/d; S 4 times/d

VAP^† ICU^§ mortality All ICU^§-acquired infections

0.69; 0.19 to 2.59 0.94; 0.51 to 1.73 0.97; 0.35 to 2.63

Medical ICU^§

JM Rodriguez-Roldan et al. 1990 [61)

Spain

13/15

Disinfection^‡‡+ Polymyxin E+ Tobramycin or Netilmicin+ Amphotericin B (P)

Disinfection^‡‡+ Inert coloring substance (P)

Oropharynx^¶

4 times/d

VAP^† In-hospital mortality

0.05; 0.0 to 0.77 0.92; 0.31 to 2.73

Multidisciplinary ICU^§

J Pugin et al. 1991 [62]

Switzerland

25/27

Polymyxin B+ Neomycin+ Vancomycin (S)

Dextrose 5% (S)

Unconscious patients: instilled into retropharynx. Conscious patients: keep the solution in buccal cavity for 1 minute and then to shallow it

Every 24 h

VAP^† In-hospital mortality

0.21; 0.08 to 0.52 1.08; 0.44 to 2.64

Surgical ICU^§

H Gastinne et al. 1992 [63]

France

220/225

Colistin+ Tobramycin+ Amphotericin B (S,G)

Nonabsorbable calcium salt (S, G)

G in oropharynx^¶; S enterally

4 times/d

VAP^† In-hospital mortality

1.3; 0.8 to 2.1 1.08; 0.89 to 1.3

Medical ICU^§

FB Cerra et al. 1992 [64]

USA

25/21

Norfloxacin (Su) + Nystatin (Su)

Cherry syrup (Su)

Enterally

Norfloxacin × 3 Nystatin ×4 limited to 15 d

ICU^§ mortality All ICU^§-acquired infections

1.08; 0.64 to 1.84 0.67; 0.41 to 1.1

Surgical ICU^§

AM Korinek et al. 1993 [65]

France

63/60

Polymyxin E+ Tobramycin+ Amphotericin B (S) and P containing same antibiotics plus Vancomycin

Sterile water (S) Carboxymethylcellulose (P)

P in oropharynx^¶ S administered enterally

4 times/d limited to 15d

VAP^† ICU^§ mortality In-hospital mortality All ICU^§-acquired infections

0.57; 0.34 to 0.97 0.57; 0.22 to 1.48 1.09; 0.59 to 2.01 0.56; 0.42 to 0.76

Neurosurgical ICU^§

J Wiener et al. 1995 [66]

USA

30/31

Polymyxin E+ Gentamicin+ Nystatin (S, P)

Inert S and P

P in oropharynx^¶ S administered enterally

4 times/d

VAP^† ICU^§ mortality All ICU^§-acquired infections

1.03; 0.45 to 2.4 0.78; 0.45 to 1.34 0.82; 0.27 to 2.53

Multidisciplinary ICU^§

B Quinio et al. 1996 [67]

France

76/72

Polymyxin E+ Gentamicin+ Amphotericin B (Su,P)^§§

Carboxymethylcell0ulose (Su, P)^§§

G in oropharynx^¶ S administered enterally

4 times/d

VAP^† ICU^§mortality All ICU^§-acquired infections

0.49; 0.31 to 0.76 1.12; 0.75 to 1.67 0.6; 0.49 to 0.75

Multiple trauma patients admitted in ICU^§

DCJJ Bergmans et al. 2001 [68]

Netherland

87/139

Polymyxin E+ Gentamicin+ Vancomycin (O)

O without antibiotics^||

Buccal cavity

Every 6 h limited to 21d

VAP^† ICU^§ mortality In-hospital mortality All ICU^§-acquired infections

0.37; 0.19 to 0.74 0.65; 0.35 to 1.21 0.71; 0.39 to 1.29 0.61;0.34 to 1.1

Multidisciplinary ICU^§

GC Wood et al. 2002 [69]

USA

20/20

Ceftazidime (A)

Normal saline (A)

Nebulizer connected to the inspiratory loop

Every 12 hours for ≥ 7d

VAP^† Mortality

0.47; 0.23 to 0.98 0.41; 0.06 to 2.41

Trauma ICU^§

I Pneumatikos et al. 2002**[70]

Greece

31/30

Polymyxin E+ Tobramycin+ Amphotericin B (S)

Placebo S

Subglottic area

Continuous infusion

VAP^† Mortality

0.37; 0.17 to 0.81 0.63; 0.14 to 2.7

Multiple trauma patients admitted in ICU^§

M Koeman et al. 2006 [57]

Netherland

128/130

CHX^¶¶ + Colistin in vaseline

Vaseline

Buccal cavity

4 times/d

VAP† ICU^§ mortality

0.82; 0.41 to 1.63 1.02; 0.66 to 1.59

Multidisciplinary ICU^§

M Kollef et al. 2006 [71]

Multinational study***

362/347

Iseganan (S)

Placebo S

Oropharynx^¶

For 2 min 6 times/d limited to 14d

VAP^† ICU^§ mortality at 14d

0.86; 0.68 to 1.09 1.28; 0.87 to 1.88

Multidisciplinary ICU^§

JA Claridge et al. 2007 [37]

USA

53/52

Ceftazidime (A)

Normal saline(A)

Nebulizer connected to the inspiratory loop

Every 12 hours for ≥ 7d

VAP^† Mortality All ICU^§ -acquired infections^†††

0.98; 0.67 to 1.43 1.08; 0.63 to 1.85 1.71; 0.67 to 4.48

Trauma ICU^§

AM de Smet et al. 2009** [38]

Netherland

1904/1990

Polymyxin E+ Amphotericin B+ Tobramycin (P)

Standard oral care^‡‡‡

Buccal cavity (only T group)

4 times/d

In-hospital mortality ICU^§ mortality Mortality at day 28 All ICU^§-acquired infections^§§§

0.95; 0.83 to 1.09 0.98; 0.84 to 1.15 0.96; 0.74 to 0.99 0.68; 0.53 to 0.86

Multidisciplinary ICU^§