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Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomized controlled trials



To determine the impact of the antifungal component of selective decontamination of the digestive tract on fungal carriage, infection and fungaemia.


Meta-analysis of randomized controlled trials of selective decontamination of the digestive tract

Study selection

Data sources included Medline, Embase, Cochrane Register of Controlled Trials, previous meta-analyses, personal communications and conference proceedings, without restriction of language or publication status. All randomized trials were selected that compared oropharyngeal and/or intestinal administration of antifungals amphotericin B or nystatin, as part of selective decontamination protocol, with no treatment in the controls. There were 42 randomized controlled trials with a total of 6,075 critically ill patients.


Three reviewers independently applied selection criteria, performed quality assessment and extracted the data. The main outcome measures were patients with fungal carriage, patients with fungal infections and patients with fungaemia. Odds ratios were pooled with the random effect model.

Measurements and results

Enteral antifungals significantly reduced fungal carriage (odds ratio 0.32, 95% confidence interval 0.19–0.53) and overall fungal infections (0.30, 0.17–0.53). Fungaemia was not significantly reduced in the treatment group (0.89, 0.16–4.95).


Antifungals, as part of selective decontamination of the digestive tract, reduce fungal carriage and infection but not fungaemia in critically ill patients and may justify the inclusion of an antifungal component in the decontamination protocol.

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  1. 1.

    Silvestri L, Mannucci F, van Saene HKF (2000) Selective decontamination of the digestive tract: a life saver. J Hosp Infect 45:185–190

  2. 2.

    Baxby D, van Saene HKF, Stoutenbeek CP, Zandstra DF (1996) Selective decontamination of the digestive tract: 13 years on, what it is and what it is not. Intensive Care Med 22:699–706

  3. 3.

    Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF (1984) The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 10:185–192

  4. 4.

    Selective decontamination of the digestive tract trialists’ collaborative group (1993) Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract. BMJ 307:525–532

  5. 5.

    Heyland DK, Cook DJ, Jaeschke R, Griffith L, Lee HN, Guyatt GH (1994) Selective decontamination of the digestive tract: an overview. Chest 105:1221–1229

  6. 6.

    Kollef M (1994) The role of selective digestive tract decontamination on mortality and respiratory tract infections. A meta-analysis. Chest 105:1101–1108

  7. 7.

    D’Amico R, Pifferi S, Leonetti C, Torri V, Tinazzi A, Liberati A (1998) Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomized controlled trials. BMJ 316:1275–1285

  8. 8.

    Nathens AB, Marshall JC (1999) Selective decontamination of the digestive tract in surgical patients. A systematic review of the evidence. Arch Surg 134:170–176

  9. 9.

    Redman R, Ludington E, Crocker M, Wittes J, Bellm L, Carlet J, and the VAP Advisory Group (2001) Analysis of respiratory and non-respiratory infections in published trials of selective digestive decontamination. Intensive Care Med 27 [Suppl 1]:S285

  10. 10.

    Liberati A, D’Amico R, Pifferi S, Torri V, Brazzi L (2004) Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev CD000022

  11. 11.

    Safdar N, Said A, Lucey MR (2004) The role of selective decontamination for reducing infection in patients undergoing liver transplant: a systematic review and meta-analysis. Liver Transpl 10:817–827

  12. 12.

    Eggiman P, Garbino J, Pittet D (2003) Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis 3:685–702

  13. 13.

    Petri G, Konig J, Moecke P, Gramm HJ, Barkow H, Kujath P, Dennhart R, Schafer H, Meyer N, Kalmar P, Thulig P, Muller J, Lode H (1997) Epidemiology in invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Intensive Care Med 23:317–325

  14. 14.

    Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections and the intensive care units in the United States. Crit Care Med 27:887–892

  15. 15.

    Rangel-Frausto MS, Wiblin T, Blumberg HM, Saiman L, Patterson J, Rinaldi M, Pfaller M, Edwards JE Jr, Jarvis W, Dawson J, Wenzel RP (1999) National epidemiology of mycoses survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin Infect Dis 29:253–258

  16. 16.

    Voss A, le Noble JLML, Verduyn Lunel FM, Foudraine NA, Meis JF (1997) Candidemia in intensive care unit patients: risk factors for mortality. Infection 25:8–11

  17. 17.

    Papazian L, Thomas P, Garbe L, Guignon I, Thirion X, Charrel J, Bollet C, Fuentes P, Gouin F (1995) Bronchoscopic or blind sampling techniques for the diagnosis of ventilator associated pneumonia. Am J Respir Crit Care Med 152:1982–1991

  18. 18.

    El-Elbiary M, Torres A, Fabregas N, Puig de la Bellacasa J, Gonzalez J, Ramirez J, del Bano D, Hernandez C, Jimenez de Anta MT (1997) Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients: an immediate post-mortem histologic study. Am J Respir Crit Care Med 156:583–590

  19. 19.

    Solomkin JS, Flohr AB, Quie PG, Simmons RL (1980) The role of Candida in intraperitoneal infection. Surgery 88:524–530

  20. 20.

    Wey SD, Mori M, Pfaller MA, Woolson RF, Wenzel RP (1989) Risk factors for hospital acquired candidemia: a matched case-control study. Arch Intern Med 149:2349–2353

  21. 21.

    Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R (1994) Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 220:751–758

  22. 22.

    Powles RL, Milliken S (1991) The prophylaxis of fungal infections. J Antimicrob Chemother 28 [Suppl A]:97–103

  23. 23.

    Silvestri L, HKF van Saene, Milanese M, Gregori D (2003) Impact of SDD on fungal carriage and infections: a meta-analysis. Intensive Care Med 29 [Suppl 1]:S128

  24. 24.

    Brazzi L, Liberati A (1992) A review of design and conduct of the available studies on selective decontamination of the digestive tract. Reanimation Urgences 1):501–507

  25. 25.

    Sarginson RE, Taylor N, van Saene HKF (2001) Glossary of terms and definitions. Curr Anaesth Crit Care 12:2–5

  26. 26.

    Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections 1988. Am J Infect Control 16:128–140

  27. 27.

    Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U (2001) Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 286:944–953

  28. 28.

    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

  29. 29.

    Whitehead A, Whitehead J (1991) A general parametric approach to the meta-analysis of randomised clinical trials. Stat Med 10:1665–1667

  30. 30.

    R Development Core Team (2003) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna (, accessed 14 June 2004)

  31. 31.

    Lumley T (2004) The rmeta package: functions for simple fixed and random effects meta-analysis, ver 2.10 (, accessed 14 June 2004)

  32. 32.

    Bergmans DCJJ, Bonten MJM, Gaillard CA, Paling JC, van der Geest S, van Tiel FH, Beysens AJ, de Leeuw PW, Stobberingh EE (2001) Prevention of ventilator-associated pneumonia by oral decontamination. A prospective, randomized, double-blind, placebo-controlled study. Am J Respir Crit Care Med 164:382–388

  33. 33.

    Brun-Buisson C, Legrand P, Rauss A, Richard C, Montravers F, Besbes M, Meakins JL, Soussy CJ, Lemaire F (1989) Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli. Study of an outbreak in an intensive care unit. Ann Intern Med 110:873–881

  34. 34.

    Pugin J, Auckenthaler R, Lew DP, Suter PM (1991) Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial. JAMA 265:2704–2710

  35. 35.

    Krueger WA, Lenhart F-P, Neeser G, Ruckdeschel G, Schreckhase H, Eissner H-J, Forst H, Eckart J, Peter K, Unertl KE (2002) Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients. A prospective, stratified, randomized, double-blind, placebo-controlled clinical trial. Am J Respir Crit Care Med 166:1029–1037

  36. 36.

    Laggner AN, Tryba M, Georgopulos A, Lenz K, Grimm G, Graninger W, Schneeweiss B, Druml W (1994) Oropharyngeal decontamination with gentamycin for long-stay ventilated patients on stress ulcer prophylaxis with sucralfate? Wien Klin Wochenschr 106:15–19

  37. 37.

    Bion JF, Badger I, Crosby HA, Hutchings P, Kong K-L, Baker J Hutton P, McMaster P, Buckels JA, Elliott TS (1994) Selective decontamination of the digestive tract reduces Gram-negative pulmonary colonization but not systemic endotoxemia in patients undergoing elective liver transplantation. Crit Care Med 22:40–49

  38. 38.

    Rolando N, Wade JJ, Stangou A, Gimson AES, Wendon J, Philpott-Howard J, Casewell MW, Williams R (1996) Prospective study comparing the efficacy of prophylactic parenteral antimicrobials. With or without enteral decontamination, in patients with acute liver failure. Liver Transpl Surg 2:8–13

  39. 39.

    Hellinger WC, Yao JD, Alvarez S, Blair JE, Cawley JJ, Paya CV, O’Brien PC, Spivey JR, Dickson RC, Harnois DM, Douglas DD, Hughes CB, Nguyen JH, Mulligan DC, Steers JL (2002) A randomized, prospective, double blinded evaluation of selective bowel decontamination in liver transplantation. Transplantation 73:1904–1909

  40. 40.

    Bouter H, Schippers EF, Luelmo SAG, Versteegh MIM, Ros P, Guiot HFL, Frolich M, van Dissel JT (2002) No effect of preoperative selective gut decontamination on endotoxemia and cytokine activation during cardiopulmonary bypass: a randomized, placebo-controlled study. Crit Care Med 30:38–43

  41. 41.

    Martinez-Pellus AE, Merino P, Bru M, Conejero R, Seller G, Munoz C, Fuentes T, Gonzalez G, Alvarez B (1993) Can selective digestive decontamination avoid the endotoxemia and cytokine activation promoted by cardiopulmonary bypass? Crit Care Med 21:1684–1691

  42. 42.

    Martinez-Pellus AE, Merino P, Bru M, Canovas J, Seller G, Sapina J, Fuentes T, Moro J (1997) Endogenous endotoxemia of intestinal origin during cardiopulmonary bypass. Role of type of flow and protective effect of selective digestive decontamination. Intensive Care Med 23:1251–1257

  43. 43.

    de Jonge E, Schultz M, Spanjaard L, Bossuyt PMM, Vroom MB, Dankert J (2003) Effects of selective decontamination of the digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 363:1011–1016

  44. 44.

    Abele-Horn M, Dauber A, Bauernfeind A, Russwurm W, Seyfarth-Metzger I, Gleich P, Ruckdeschel G (1997) Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD). Intensive Care Med 23:1878–1895

  45. 45.

    Aerdts SJA, van Dalen R, Clasener HAL, Festen J, van Lier HJJ, Vollaard EJ (1991) Antibiotic prophylaxis of respiratory tract infection in mechanically ventilated patients. A prospective, blinded, randomized trial of the effect of a novel regimen. Chest 100:783–791

  46. 46.

    Arnow PA, Caradang GC, Zabner R, Irwin ME (1996) Randomized controlled trial of selective decontamination for prevention of infections following liver transplantation. Clin Infect Dis 22:997–1003

  47. 47.

    Barret JP, Jeschke MG, Herndon DN (2001) Selective decontamination of the digestive tract on severely burned pediatric patients. Burns 27:439–445

  48. 48.

    Blair P, Rowlands BJ, Lowry K, Webb H, Armstrong P, Smilie J (1991) Selective decontamination of the digestive tract: a stratified, randomized, prospective study in a mixed intensive care unit. Surgery 110:303–310

  49. 49.

    Boland JP, Sadler DL, Stewart W, Wood DJ, Zerick W, Snodgrass KR (1991) Reduction of nosocomial respiratory tract infections in the multiple trauma patients requiring mechanical ventilation by selective parenteral and enteral antisepsis regimen (SPEAR) in the intensive care (abstract). 17th Congress of Chemotherapy, Berlin

  50. 50.

    Cerra FB, Maddaus MA, Dunn DL, Wells CL, Kostantinides NN, Lehman SL, Mann HJ (1992) Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care unit patients. Arch Surg 127:163–169

  51. 51.

    Cockerill FR, Muller SR, Anhalt JP, Marsh HM, Farnell MB, Mucha P, Gillespie DJ, Ilstrup DM, Larson-Keller JJ, Thompson RL (1992) Prevention of infection in critically ill patients by selective decontamination of the digestive tract. Ann Intern Med 117:545–553

  52. 52.

    de la Cal MA, Cerdà E, Garcia-Hierro P, van Saene HKF, Gomez-Santos D, Negro E, Lorente JA (2005) Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract. A randomized, placebo-controlled, double-blind trial. Ann Surg 241:424–430

  53. 53.

    Ferrer M, Torres A, Gonzalez J, Puig de la Bellacasa J, El-Ebiary M. Roca M, Gatell JM, Rodriguez-Roisin R (1994) Utility of selective decontamination in mechanically ventilated patients. Ann Intern Med 120:389–395

  54. 54.

    Finch RG, Tomlinson P, Holliday M, Sole K, Stack C, Rocker G (1991) Selective decontamination of the digestive tract (SDD) in the prevention of secondary sepsis in a medical/surgical intensive care unit (abstract). 17th Congress of Chemotherapy, Berlin

  55. 55.

    Flaherty J, Nathan C, Kabins SA, Weinstein RA (1990) Pilot trial of selective decontamination for prevention of bacterial infection in an intensive care unit. J Infect Dis 162:1393–1397

  56. 56.

    Gastinne H, Wolff M, Delatour F, Faurisson F, Chevret S, for the French Study Group on selective decontamination of the digestive tract (1992) A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med 326:594–599

  57. 57.

    Gaussorges P, Salord F, Sirodot M, Tigaud S, Cagnin S, Gerard M, Robert D (1991) Efficacite de la decontamination digestive sur la survenue des bacteriemies nosocomiales chez les patients sous ventilation mecanique et recevant des betamimetiques. Reanimation Soins Intens Med Urgence 7:169–174

  58. 58.

    Georges B, Mazerolles M, Decun J-F, Rouge P, Pomies S, Cougot P, Andrieu P, Virenque C (1994) Decontamination digestive selective: resultats d’une etude chez le polytraumatise. Reanimation Urgences 3:621–627

  59. 59.

    Hammond JMJ, Potgieter PD, Saunders GL, Forder AA (1992) Double-blind study of selective decontamination of the digestive tract in intensive care. Lancet 340:5–9

  60. 60.

    Jacobs S, Foweraker JE, Roberts SE (1992) Effectiveness of selective decontamination of the digestive tract (SDD) in an ICU with a policy encouraging a low gastric pH. Clin Intensive Care 3:52–58

  61. 61.

    Kerver AJH, Rommes JH, Mevissen-Verhage EAE, Hulstaert PF, Vos A, Verhoef J, Wittebol P (1988) Prevention of colonization and infection in critically ill patients: a prospective randomized study. Crit Care Med 16:1087–1093

  62. 62.

    Korinek AM, Laisne MJ, Nicolas MH, Raskine L, Deroin V, Sanson-Lepors MJ (1993) Selective decontamination of the digestive tract in neurosurgical intensive care unit patients: a double-blind, randomized, placebo-controlled study. Crit Care Med 21:1466–1473

  63. 63.

    Lingnau W, Berger J, Javorsky F, Lejeune P, Mutz N, Benzer H (1997) Selective intestinal decontamination in multiple trauma patients: prospective, controlled trial. J Trauma 42:687–694

  64. 64.

    Luiten EJT, Hop WCJ, Lange JF, Bruining HA (1995) Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis. Ann Surg 222:57–65

  65. 65.

    Palomar M, Alvarez-Lerma F, Jorda R, Bermejo B and the Catalan study group of nosocomial pneumonia prevention (1997) Prevention of nosocomial infection in mechanically ventilated patients: selective digestive decontamination versus sucralfate. Clin Intensive Care 8:228–235

  66. 66.

    Pneumatikos I, Koulouras V, Nathanail C, Goe D, Nakos G (2002) Selective decontamination of subglottic area in mechanically ventilated patients with multiple trauma. Intensive Care Med 28:432–437

  67. 67.

    Quinio B, Albanese J, Bues-Charbit M, Viaviand X, Martin C (1996) Selective decontamination of the digestive tract in multiple trauma patients. A prospective double-blind, randomized, placebo-controlled study. Chest 109:765–772

  68. 68.

    Rayes N, Seehofer D, Hansen S, Boucsein K, Muller AR, Serke S, Bengmark S, Neuhaus P (2002) Early enteral supply of Lactobacillus and fiber versus selective bowel decontamination: a controlled trial in liver transplant recipients. Transplantation 74:123–128

  69. 69.

    Rocha LA, Martin MJ, Pita S, Paz J, Seco C, Margusino L, Villanueva R, Duran MT (1993) Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract. A randomized, double-blind, placebo controlled study. Intensive Care Med 18:398–404

  70. 70.

    Rodriguez-Roldan JM, Altuna-Cuesta A, Lopez A, Carrillo A, Garcia J, Leon J Martinez-Pellus AJ (1990) Prevention of nosocomial lung infection in ventilated patients: use of an antimicrobial pharyngeal nonabsorbable paste. Crit Care Med 18:1239–1242

  71. 71.

    Rolando N, Gimson A, Wade J, Philpott-Howard J, Casewell M, Williams R (1993) Prospective controlled trial of selective parenteral and enteral antimicrobial regimen in fulminant liver failure. Hepatology 17:196–201

  72. 72.

    Ruza F, Alvarado F, Herruzo R, Delgado MA, Garcia S, Dorao P, Godel F (1998) Prevention of nosocomial infection in a pediatric intensive care unit (PICU) through the use of selective digestive decontamination. Eur J Epidemiol 14:719–727

  73. 73.

    Sanchez Garcia M, Cambronero Galache JA, Lopez Diaz J, Cerda Cerda E, Rubio Blasco J, Gomez Aguinaga MA, Nunez Reiz A, Rogero Marin S, Onoro Canaveral JJ, Sacristan del Castillo JA (1998) Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients. A randomized, double-blind, placebo-controlled, multicenter trial. Am J Respir Crit Care Med 158:908–916

  74. 74.

    Schardey HM, Joosten U, Finke U, Staubach KH, Schauer R, Heiss A, Kooistra A, Rau HG, Nibler R, Ludeling S, Unertl K, Ruckdeschel G, Exner H, Schildberg FW (1997) The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled, multicenter trial. Ann Surg 225:172–180

  75. 75.

    Smith SD, Jackson RJ, Hannakan CJ, Wadowsky RM, Tzakis AG, Rowe MI (1993) Selective decontamination in pediatric liver transplants. A randomized prospective study. Transplantation 55:1306–1309

  76. 76.

    Stoutenbeek CP, van Saene HKF, Zandstra DF (1996) Prevention of multiple organ failure by selective decontamination of the digestive tract in multiple trauma patients. In: Faist E, Baue AE, Schildberg FW (eds) The immune consequences of trauma, shock and sepsis—mechanisms and therapeutic approach. Pabst Science Publishers, Lengerich, pp 1055–1066

  77. 77.

    Tetteroo GWM, Wagenvoort JHT, Castelein A, Tilanus HW, Ince C, Bruining HA (1990) Selective decontamination to reduce gram-negative colonisation and infections after oesophageal resection. Lancet 335:704–707

  78. 78.

    Ulrich C, Harinck-de Weerd JE, Bakker NC, Jacz K, Doornbos L, de Ridder VA (1989) Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intensive Care Med 15:424–431

  79. 79.

    Unertl K, Ruckdeschel G, Selbmann HK, Jensen U, Forst H, Lenhart FP, Peter K (1987) Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med 13:106–113

  80. 80.

    Verwaest C, Verhaegen J, Ferdinande P, Schetz M, van den Berghe G, Verbist L, Lauwers P (1997) Randomized, controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multidisciplinary intensive care unit. Crit Care Med 25:63–71

  81. 81.

    Wiener J, Itokazu G, Nathan C, Kabins SA, Weinstein RA (1995) A randomized, double-blind, placebo-controlled trial of selective digestive decontamination in a medical-surgical intensive care unit. Clin Infect Dis 20:861–867

  82. 82.

    Winter R, Humphreys H, Pick A, MacGowan AP, Willatts SM, Speller DCE (1992) A controlled trial of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection. J Antimicrob Chemother 30:73–87

  83. 83.

    Zobel G, Kutting M, Grubbauer H-M, Semmelrock H-J, Thiel W (1991) Reduction of colonization and infection rate during pediatric intensive care by selective decontamination of the digestive tract. Crit Care Med 19:1242–1246

  84. 84.

    Zwaveling JH, Maring JK, Klompmaker IJ, Haasgma EB, Bottema JT, Laseur M, van Eckenvort PJ, TenVerget EM, Metselaar HJ, Bruining HA, Slooff MJH (2002) Selective decontamination of the digestive tract to prevent postoperative infection: a randomized placebo-controlled trial in liver transplant patients. Crit Care Med 30:1204–1209

  85. 85.

    Lingnau W, Berger J, Javorsky F, Fille M, Alleberger F, Benzer H (1998) Changing bacterial ecology during a five year period of selective intestinal decontamination. J Hosp Infect 39:195–206

  86. 86.

    Feltis BA, Wells CL (2000) Does microbial translocation play a role in critical illness? Curr Opin Crit Care 6:117–122

  87. 87.

    Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, Pfaller MA, Rangel-Frausto MS, Rinaldi MG, Saiman L, Wiblin RT, Wenzel R, and the NEMIS study group (2001) Risk factors for Candida bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. Clin Infect Dis 33:177–186

  88. 88.

    Rex JH, Sobel JD (2001) Prophylactic antifungal therapy in the Intensive Care Unit. Clin Infect Dis 32:1191–1200

  89. 89.

    Eggimann P, Francioli P, Bille J, Schneider R, Wu MM, Chapuis G, Chiolero R, Pannatier A, Schilling J, Geroulanos S, Glauser MP, Calandra T (1999) Fluconazole prophylaxis prevents intraabdominal candidiasis in high-risk surgical patients. Crit Care Med 27:1066–1072

  90. 90.

    Garbino J, Lew D, Romand J-A, Hugonnet S, Auckenthaler R, Pittet D (2002) Prevention of severe Candida infections in non-neutropenic, high risk, critically ill patients: a randomized, double-blind, placebo-controlled trial in SDD-treated patients. Intensive Care Med 28:1708–1717

  91. 91.

    Jacobs S, Price Evans DA, Tariq M, Al Omar NF (2003) Fluconazole improves survival in septic shock: a randomized double-blind prospective study. Crit Care Med 31:1938–1946

  92. 92.

    Sandwen P, Qvist H, Skovlund E, Giercksky KE (1999) Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforation. Crit Care Med 30:541–547

  93. 93.

    Slotman GJ, Burchard KW (1987) Ketoconazole prevents Candida sepsis in critically ill surgical patients. Arch Surg 122:147–151

  94. 94.

    Savino JA, Agarwal N, Wry P, Policastro A, Cerabona T, Austria L (1994) Routine prophylactic antifungal agents (clotrimazole, ketoconazole, and nystatin) in nontransplant/nonburned critically ill surgical and trauma patients. J Trauma 36:20–26

  95. 95.

    Pelz RK, Hendrix CW, Swoboda SM, Diener-West M, Merz WG, Hammond J, Lipsett PA (2001) Double-blind, placebo-controlled trial of fluconazole to prevent Candida infections in critically ill surgical patients. Ann Surg 233:542–548

  96. 96.

    Ables AZ, Blumer NA, Valainis GT, Godenick MT, kajdasz DK, Palesch YY (2000) Fluconazole prophylaxis of severe Candida infection in trauma and postsurgical patients: a prospective, double-blind, randomized, placebo-controlled trial. Infect Dis Clin Pract 9:169–175

  97. 97.

    Lumbreras C, Cuervas-Mons V, Jara P, del Palacio A, Turriòn VS, Barrios C, Moreno E, Noriega AR, Paya CV (1996) Randomized trail of fluconazole versus nystatin for the prophylaxis of Candida infection following liver transplantation. J Infect Dis 174:583–588

  98. 98.

    Singh N (2001) Trends in the epidemiology of opportunistic fungal infections: predisposing factors and the impact of antimicrobial use practices. Clin Infect Dis 33:1692–1696

  99. 99.

    Juni P, Altman DG, Egger M (2001) Assessing the quality of controlled trials. BMJ 323:42–46

  100. 100.

    Sweeting MJ, Sutton AJ, Lambert PC (2004) What to add to nothing. Use and avoidance of continuity corrections in meta-analysis of sparse data. Stat Med 23:1351–1375

  101. 101.

    Nolla-Salas J, Sitges-Serra A, Leon-Gil C, Martinez-Gonzalez J, Leon-Regidor MA, Ibanez-Lucia P, Torres-Rodriguez JM (1997) Candidemia in non-neutropenic critically ill patients: analysis of prognostic factors and assessment of systemic antifungal therapy. Intensive Care Med 23:23–30

  102. 102.

    Wenzel RP (1995) Nosocomial candidemia: risk factors and attributable mortality. Clin Infect Dis 20:1531–1534

  103. 103.

    Slotman GJ, Saphiro R, Moffa SM (1994) Fungal sepsis: multisite colonization versus fungemia. Ann Surg 60:107–113

  104. 104.

    Rentz AM, Halpern MT, Bowden R (1998) The impact of candidemia on length of hospital stay, outcome and overall cost of illness. Clin Infect Dis 27:781–788

  105. 105.

    Rocco TR, Reinert S, Simms H (2000) Effects of fluconazole administration in critically ill patients. Analysis of bacterial and fungal resistance. Arch Surg 135:160–165

  106. 106.

    Gleason TG, May AK, Capparelli D, Farr BM, Sawyer RG (1997) Emerging evidence of selection of fluconazole-tolerant fungi in surgical intensive care units. Arch Surg 132:1197–1202

  107. 107.

    Trick WE, Fridkin SK, Edwards JR, Hajjeh RA, Gaynes RP, National Nosocomial Infections Surveillance System Hospitals (2002) Secular trends of hospital-acquired candidemia among intensive care unit patients in the United States during 1989–1999. Clin Infect Dis 35:627–630

  108. 108.

    Donnelly JP, De Pauw BE (2004) Voriconazole-a new therapeutic agent with an extended spectrum of antifungal activity. Clin Microbiol Infect 10 [Suppl 1]:107–117

  109. 109.

    Masià Canuto M, Gutierrez Rodero F (2002) Antifungal drug resistance to azoles and polyenes. Lancet Infect Dis 2:550–583

  110. 110.

    van Saene HKF, Damjanovic V, Pizer B, Petros AJ (1999) Fungal infections in ICU. J Hosp Infect 41:337–340

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We are very grateful to Dr. M.A. de la Cal and Dr. K. Thorburn for carefully reviewing of the manuscript.

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Correspondence to Luciano Silvestri.

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Silvestri, L., van Saene, H.K.F., Milanese, M. et al. Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomized controlled trials. Intensive Care Med 31, 898–910 (2005).

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  • Antibiotic prophylaxis
  • Antifungal agents
  • Carriage
  • Selective decontamination