James C Hurley1,2. 1. Rural Health Academic Center, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia. 2. Division of Internal Medicine, Ballarat Health Services, Ballarat, Victoria, Australia.
Abstract
Multiple individual studies of selective digestive decontamination/selective oropharyngeal decontamination (SDD/SOD) among ICU patients appear to show potent infection prevention effects. Surprisingly, the event rates for multiple endpoints including ventilator-associated pneumonia, bacteraemia and candidaemia among concurrent control groups within SDD/SOD studies appear unusually high versus other rates in the literature. These paradoxical observations raise concern that the contextual effects of SDD/SOD, as postulated in the original SDD/SOD study, not only exist but also are strong. Until these effects are addressed within an optimally designed study, the safety of SDD/SOD within the 'whole of ICU' remains questionable.
Multiple individual studies of selective digestive decontamination/selective oropharyngeal decontamination (SDD/SOD) among ICU patients appear to show potent infection prevention effects. Surprisingly, the event rates for multiple endpoints including ventilator-associated pneumonia, bacteraemia and candidaemia among concurrent control groups within SDD/SOD studies appear unusually high versus other rates in the literature. These paradoxical observations raise concern that the contextual effects of SDD/SOD, as postulated in the original SDD/SOD study, not only exist but also are strong. Until these effects are addressed within an optimally designed study, the safety of SDD/SOD within the 'whole of ICU' remains questionable.
Authors: Lucas H P Bernts; Shosha E I Dekker; Darius Soonawala; Roger J M Brüggemann; Heiman F L Wertheim; Johan W de Fijter; Joost P H Drenth; Marten A Lantinga Journal: J Antimicrob Chemother Date: 2020-09-01 Impact factor: 5.790