ICU-acquired candidemia within selective digestive decontamination studies: a meta-analysis

Hurley, James C.

doi:10.1007/s00134-015-4004-x

Cited by 34 publications

(28 citation statements)

References 41 publications

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“…Only 45 of the studies are common to this meta-analysis and to the previous meta-analysis of candidemia [121]. This previous meta-analysis [121] was not restricted to the patient population receiving mechanical ventilation and had included a higher proportion of studies with group wide risk factors for candidemia (25 of the 103 studies [121] ) versus only six of the 113 studies included here. As a consequence, there is a lower incidence of candidemia among the studies here versus previously [121].…”

Section: Discussionmentioning

confidence: 99%

“…This previous meta-analysis [121] was not restricted to the patient population receiving mechanical ventilation and had included a higher proportion of studies with group wide risk factors for candidemia (25 of the 103 studies [121] ) versus only six of the 113 studies included here. As a consequence, there is a lower incidence of candidemia among the studies here versus previously [121]. However, even within this differently selected set of studies, the incidence of candidemia is again found to be higher among the control groups of SDD studies with a concurrent design than any other type of component group (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Candidemia, with an incidence of approximately 1% amongst ICU patients [121], is a rare outcome and studies with fewer than 100 patients may have one or no cases [143][144][145][146][147][148][149]. The relationship described here is at the group level rather than at the patient level.…”

Section: Discussionmentioning

confidence: 99%

“…This question was raised in the first study of SDD [74,142]. There appear to be subtle contextual effects of using topical antibiotics in the ICU on the incidence of candidemia [121], as with bacteremia [122] and also as with Ventilator Associated Pneumonia [123], which are -evident only through benchmarking the control group rates of these studies and which are not seen in studies of non-TA methods of ICU infection prevention.…”

Section: Introductionmentioning

confidence: 99%

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Impact of selective digestive decontamination on respiratory tract Candida among patients with suspected ventilator-associated pneumonia. A meta-analysis

Hurley

2016

Eur J Clin Microbiol Infect Dis

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The purpose here is to establish the incidence of respiratory tract colonization with Candida (RT Candida) among ICU patients receiving mechanical ventilation within studies in the literature. Also of interest is its relationship with candidemia and the relative importance of topical antibiotic (TA) use as within studies of selective digestive decontamination (SDD) versus other candidate risk factors towards it. The incidence of RT Candida was extracted from component (control and intervention) groups decanted from studies of various TA and non-TA ICU infection prevention methods with summary estimates derived using random effects. A benchmark RT Candida incidence to provide overarching calibration was derived using (observational) groups from studies without any prevention method under study. A multi-level regression model of group level data was undertaken using generalized estimating equation (GEE) methods. RT Candida data were sourced from 113 studies. The benchmark RT Candida incidence is 1.3; 0.9-1.8 % (mean and 95 % confidence intervals). Membership of a concurrent control group of a study of SDD (p = 0.02), the group-wide presence of candidemia risk factors (p < 0.001), and proportion of trauma admissions (p = 0.004), but neither the year of study publication, nor membership of any other component group, nor the mode of respiratory sampling are predictive of the RT Candida incidence. RT Candida and candidemia incidences are correlated. RT Candida incidence can serve as a basis for benchmarking. Several relationships have been identified. The increased incidence among concurrent control groups of SDD studies cannot be appreciated in any single study examined in isolation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of selective digestive decontamination on respiratory tract Candida among patients with suspected ventilator-associated pneumonia. A meta-analysis

Hurley

2016

Eur J Clin Microbiol Infect Dis

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“…In each case, the increased incidence within control groups of CC design studies of topical antibiotics remains apparent in meta-regression models adjusting for other recognized associations. The influence of topical placebo use, concurrent colonization with Candida, and other influences may also have influences in this process [45][46][47].…”

Section: Limitationsmentioning

confidence: 99%

Structural equation modeling the “control of gut overgrowth” in the prevention of ICU-acquired Gram-negative infection

Hurley

2020

Crit Care

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Background: Conceptually, the "control of gut overgrowth" (COGO) is key in mediating prevention against infection with Gram-negative bacilli by topical antibiotic prophylaxis, a common constituent of selective digestive decontamination (SDD) regimens. However, the relative importance of the other SDD components, enteral and protocolized parenteral antibiotic prophylaxis, versus other methods of infection prevention and versus other contextual exposures cannot be resolved within individual studies. Methods: Seven candidate generalized structural equation models founded on COGO concepts were confronted with Pseudomonas and Acinetobacter bacteremia as well as ventilator-associated pneumonia data derived from > 200 infection prevention studies. The following group-level exposures were included in the models: use and mode of antibiotic prophylaxis, anti-septic and non-decontamination methods of infection prevention; proportion receiving mechanical ventilation; trauma ICU; mean length of ICU stay; and concurrency versus non-concurrency of topical antibiotic prophylaxis study control groups. Results: In modeling Pseudomonas and Acinetobacter gut overgrowth as latent variables, anti-septic interventions had the strongest negative effect against Pseudomonas gut overgrowth but no intervention was significantly negative against Acinetobacter gut overgrowth. Strikingly, protocolized parenteral antibiotic prophylaxis and concurrency each have positive effects in the model, enteral antibiotic prophylaxis is neutral, and Acinetobacter bacteremia incidences are high within topical antibiotic prophylaxis studies, moreso with protocolized parenteral antibiotic prophylaxis exposure. Paradoxically, topical antibiotic prophylaxis (moreso with protocolized parenteral antibiotic prophylaxis) appears to provide the strongest summary prevention effects against overall bacteremia and overall VAP.Conclusions: Structural equation modeling of published Gram-negative bacillus infection data enables a test of the COGO concept. Paradoxically, Acinetobacter and Pseudomonas bacteremia incidences are unusually high among studies of topical antibiotic prophylaxis.Tweet GSEM modeling of Pseudomonas and Acinetobacter gut overgrowth demonstrates complex and paradoxical relationships within SDD/SOD studies.

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Severe Burns: Pathogenesis and Prevention of Infection

Hurley

2017

Burns, Infections and Wound Management

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ICU-acquired candidemia within selective digestive decontamination studies: a meta-analysis

Cited by 34 publications

References 41 publications

Impact of selective digestive decontamination on respiratory tract Candida among patients with suspected ventilator-associated pneumonia. A meta-analysis

Impact of selective digestive decontamination on respiratory tract Candida among patients with suspected ventilator-associated pneumonia. A meta-analysis

Structural equation modeling the “control of gut overgrowth” in the prevention of ICU-acquired Gram-negative infection

Severe Burns: Pathogenesis and Prevention of Infection

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