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Table 4 Meta-analysis results of effectiveness of topical decontamination in reducing VAP, mortality and all ICU-acquired infections

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

  Antiseptics   Antibiotics  
VAPPrevention No. Studies No. Patients Overall Risk Ratio (Efficacy,
%)
95% Confidence Interval (Efficacy interval,%) Heterogeneity Test (Q; P; I2,%) No. Studies No. Patients Overall Risk Ratio (Efficacy,%) 95% Confidence Interval (Efficacy interval, %) Heterogeneity Test (Q; P; I2,%)
All studies 11 3,258 0.73 (27) 0.63 to 0.84 (16 to 37) 13.78; 0.18; 27.4 15 2,463 0.64 (36) 0.5 to 0.82 (18 to 50) 47.09; <0.001; 70.3
High quality 6 2,161 0.77 (23) 0.66 to 0.9 (10 to 34) 4.62; 0.46; 0 11 2,249 0.69 (31) 0.54 to 0.89 (11 to 46) 34.66; <0.001; 71.2
Low quality 5 1,097 0.6 (40) 0.44 to 0.82 (18 to 56) 8.99; 0.06; 55.5 4 214 0.35 (65) 0.14 to 0.86 (14 to 86) 5.64; 0.13; 46.8
Only specialty surgery ICU* 4 1,966 0.52 (48) 0.38 to 0.71 (29 to 62) 3.55; 0.31; 15.5 3 260 0.4 (60) 0.2 to 0.8 (20 to 80) 5.64; 0.06; 64.6
Only trauma patients NA - - - - 4 354 0.6 (40) 0.38 to 0.93 (7 to 62) 8.2; 0.04; 63.4
Mixed ICU* 6 1,117 0.82 (18) 0.68 to 1.00 (0 to 32) 5.77; 0.33; 13.3 6 1,318 0.7 (30) 0.46 to 1.05 (-5 to 54) 13.41; 0.02; 62.7
Only double blinded studies Same high quality meta-analysis   12 2,277 0.67 (33) 0.52 to 0.87 (13 to 48) 39.53; <0.001; 72.2
Not double blinded studies Same low quality meta-analysis   3 186 0.44 (56) 0.21 to 0.92 (8 to 79) 2.83; 0.24; 29.3
Using same antibiotics combination:           
   Cyclic peptide + aminoglycoside + polyene antifungal drug - - - - - 6 782 0.60 (40) 0.35 to 1.04 (-4 to 65) 22.21; <0.001; 77.5
   Vancomycin + other antimicrobial agents - - - - - 3 401 0.43 (57) 0.24 to 0.78 (22 to 76) 5.3; 0.07; 62.3
Digestive tract decontamination with antibiotics - - - - - 11 2,172 0.67 (33) 0.5 to 0.9 (10 to 50) 35.99; <0.001; 72.2
Respiratory tract decontamination with antibiotics - - - - - 4 291 0.54 (46) 0.3 to 0.97 (3 to 97) 9.67; 0.02; 69
Mortality           
All studies 12 3,224 1.1 (-10) 0.98 to 1.24 (-24 to 2) 9.89; 0.54; 0 17 6,403 1.02 (-2) 0.93 to 1.13 (-13 to 7) 9.82; 0.88; 0
High quality 6 2,132 1.09 (-9) 0.9 to 1.32 (-32 to 10) 3.59; 0.61; 0 12 2,295 1.06 (-6) 0.94 to 1.2 (-20 to 6) 8.55;0.66;0
Low quality 6 1,192 1.11 (-11) 0.96 to 1.29 (-29 to 4) 6.27; 0.28; 20.3 5 4,108 0.97 (3) 0.84 to 1.12 (-12 to 16) 0.38; 0.98; 0
Only ICU* mortality 8 1,751 1.08 (-8) 0.92 to 1.26 (-26 to 8) 4.9; 0.67; 0 14 5,878 1.01 (-1) 0.9 to 1.12 (-12 to 10) 9.39; 0.74; 0
Only in-hospital mortality 4 1,573 0.95 (5) 0.95 to 1.37 (-37 to 5) 4.74; 0.19; 36.7 6 4,768 0.98 (2) 0.88 to 1.09 (-9 to 12) 2.43; 0.79; 0
Only double blinded studies Same high quality meta-analysis   13 2,323 1.06 (-6) 0.94 to 1.2 (-20 to 6) 8.59; 0.74; 0
Not double blinded studies Same low quality meta-analysis   4 4,080 0.97 (3) 0.84 to 1.12 (-12 to 16) 0.37; 0.95; 0
Using same antibiotics combination:           
   Cyclic peptide + aminoglycoside + polyene antifungal drug -   - - - 7 4,676 0.99 (1) 0.89 to 1.09 (-9 to 11) 2.62; 0.85; 0
   Vancomycin + other antimicrobial agents - - - - - 3 401 0.89 (11) 0.59 to 1.35 (-35 to 41) 1.06; 0.59; 0
Digestive tract decontamination with antibiotics - - - - - 13 6,112 1.01 (-1) 0.92 to 1.12 (-12 to 8) 6.72; 0.87; 0
Respiratory tract decontamination with antibiotics - - - - - 4 291 1.17 (-17) 0.85 to 1.61 (-61 to 15) 2.36; 0.5; 0
All ICU*-Acquired infections           
All studies 4 1,595 1.02 (-2) 0.41 to 2.51 (-151 to 59) 20.14; <0.001; 85.1 9 4,774 0.71 (29) 0.59 to 0.86 (14 to 41) 18.62; 0.02; 57
High quality 3 1,535 0.59 (41) 0.47 to 0.76 (0.24 to 53) 3.9; 0.14; 48.7 7 794 0.64 (36) 0.56 to 0.73 (27 to 44) 7.57; 0.27; 20.7
Low quality NA - - - - 2 3,980 0.89 (11) 0.52 to 1.52 (-52 to 48) 6.57; 0.01; 84.8
Only specialty surgery ICU* 2 1,307 0.55 (45) 0.43 to 0.72 (28 to 57) 1.19; 0.28; 16 4 340 0.71 (29) 0.45 to 1.11 (-11 to 55) 12.15; 0.007; 75.3
Mixed ICU* 2 288 3.02 (-202) 0.34 to 27.12 (-2.61 to 66) 8.2; 0.004; 87.8 3 4,181 0.7 (30) 0.59 to 0.85 (15 to 41) 0.65; 0.72; 0
Using same antibiotics combination:           
   Cyclic peptide + aminoglycoside + polyene + antifungal drug - - - - - 3 4,103 0.66 (34) 0.57 to 0.76 (24 to 43) 1.91; 0.38; 0
   Vancomycin + other antimicrobial agents - - - - - 2 349 0.53 (43) 0.44 to 0.74 (26 to 56) 0.07; 0.79; 0
Digestive tract decontamination with antibiotics - - - - - 7 4,584 0.7 (30) 0.58 to 0.84 (16 to 42) 14.11; 0.03; 57.5
Respiratory tract decontamination with antibiotics - - - - - 2 190 0.87 (13) 0.22 to 3.35 (-235 to 78) 3.95; 0.05; 74.7
  1. * Intensive care units, ventilator associated pneumonia, not applicable because only one study belongs to this group.