Efficacy And Safety Of Selective Digestive Decontamination Versus Selective Oropharyngeal Decontamination In ICU Patients: A Meta-analysis Of Randomized Controlled Trials

Objective: To evaluate the efficacy and safety of selective digestive decontamination(SDD)versus selective oropharyngeal decontamination(SOD)in ICU patients.Methods: PubMed,Embase,Cochrane Central Register of Controlled Trials,CNKI?VIP and Wanfang databases were searched up to March 30,2020.The quality of the included studies was assessed using the randomized controlled trial(RCT)bias risk assessment tool recommended by the Cochrane Handbook.Meta-analysis was performed by RevMan 5.3software.Results: Eight RCT studies involving 24190 patients were included.In terms of efficacy,SDD had a lower incidence of ICU-acquired bacteremia(RR = 0.72,95% CI:0.57-0.90)compared with SOD;in terms of safety,SDD had a lower prevalence of antibiotic-resistant gram-negative bacteria in rectal tract samples(RR = 0.60,95% CI:0.49-0.72)andprevalence of acquired antibiotic-resistant gram-negative bacteria in respiratory tract samples(RR = 0.73,95% CI:0.64-0.83)compared with SOD.However,there was no significant difference between SDD and SOD in day-28 mortality(RR = 1.00,95% CI: 0.93-1.07),ICU mortality(RR =0.97,95% CI: 0.92-1.02),in-hospital mortality(RR = 1.02,95% CI:0.95-1.08),incidence of ICU-acquired bacteremia with highly resistant microorganisms(RR = 0.73,95% CI: 0.46-1.14),prevalence of antibiotic-resistant gram-negative bacteria in respiratory tract samples(RR= 0.87,95% CI: 0.73-1.04),length of ICU stay(WMD = 0.31 days,95%CI:-0.29,0.90),length of hospital stay(WMD = 0.18 days,95% CI:-0.41,0.77)and duration of mechanical ventilation(WMD = 0.01 days,95% CI:-1.95,1.97)for ICU patients.Conclusion: SDD has better efficacy and safety compared with SOD.