Premium
Untargeted antifungal therapy in adult patients with complicated intra‐abdominal infection: a systematic review
Author(s) -
Petersen M. W.,
Perner A.,
Ravn F.,
Sjövall F.,
Møller M. H.
Publication year - 2018
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13031
Subject(s) - medicine , placebo , meta analysis , antifungal , relative risk , confidence interval , clinical trial , randomized controlled trial , medline , subgroup analysis , systematic review , intensive care medicine , alternative medicine , pathology , dermatology , political science , law
Background Systematic reviews comparing untargeted antifungal treatment with placebo or no treatment in critically ill patients have provided conflicting results. We aimed to assess patient‐important benefits and harms of untargeted antifungal therapy vs. placebo or no treatment in adult patients with complicated intra‐abdominal infection. Methods We conducted a systematic review with meta‐analysis and trial sequential analysis of randomised clinical trials assessing untargeted antifungal therapy compared to placebo or no treatment in adults with complicated intra‐abdominal infection. We used the Cochrane and GRADE methodologies and exclusively assessed patient‐important outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias. We performed conventional meta‐analyses, including sensitivity and subgroup analyses, and trial sequential analysis to assess the risk of random errors and to estimate trial sequential analysis adjusted confidence intervals. Results We included six trials (1,067 patients) in the review, and four trials reported data on the predefined outcome measures and were included in the meta‐analysis. Three of the four trials had high risk of bias. We observed no statistically significant difference in mortality (relative risk 0.58, 95% confidence interval 0.24–1.39) or in any of the other patient‐important outcomes between untargeted antifungal treatment and placebo or no treatment (low/very low quality of evidence). Trial sequential analysis demonstrated lack of data and high risk of random errors. Conclusions The quantity and quality of evidence supporting untargeted antifungal treatment in adult patients with complicated intra‐abdominal infection are low to very low with no firm evidence for benefit or harm.