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

From: Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units

Authors Country Units of treatment T/C* Interventions Delivery mode Daily amount and timing Outcomes Odds Ratio; 95% Confidence Interval Population
    Treatment Control      
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§
  1. A, aerosol; g, gel; o, orabase; p, paste; s, solution; su, suspension
  2. * treatment/control, ventilator associated pneumonia, § intensive care units, | randomized study blinded for radiologic diagnosis, buccal, pharyngeal, gingival, tongue and tooth surfaces, ** not blind randomized study, †† disinfection with a povidone-iodine solution, ‡‡ disinfection with a 0.1% chlorhexidine solution, §§ both groups received nasal and oropharyngeal toilet with povidone-iodine before each treatment or placebo application, || two separate control groups: control a (78) was studied in the presence of patients receiving topical antimicrobial prophylaxis; control b (61) was studied in ICU where no topical antimicrobial prophylaxis was used
  3. ¶¶ chlorhexidine gluconate, *** France, Spain, Switzerland, Netherland, UK, USA, ††† multi-drug-resistant infections, ‡‡‡ mouth rinsing with water 4 times a day and tooth brushing twice daily, §§§ patients with at least one episode of bacteremia or candidemia acquired in ICU.