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

VAP^†Prevention

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