Untargeted antifungal therapy in adult patients with complicated intra-abdominal infection : A systematic review
Petersen, M. W. ; Perner, A. ; Ravn, F. ; Sjövall, F. LU
and Møller, M. H.
(2018)
In Acta Anaesthesiologica Scandinavica
62(1).
p.6-18
- Abstract
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... (More)
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.
(Less)
- author
- Petersen, M. W.
; Perner, A.
; Ravn, F.
; Sjövall, F.
LU
and Møller, M. H.
- organization
- publishing date
- 2018-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Acta Anaesthesiologica Scandinavica
- volume
- 62
- issue
- 1
- pages
- 6 - 18
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85033482965
- pmid:29124727
- wos:000417184800002
- ISSN
- 0001-5172
- DOI
- 10.1111/aas.13031
- language
- English
- LU publication?
- yes
- id
- 8580f0d8-e80e-4467-b991-940d3632eb55
- date added to LUP
- 2017-12-12 16:09:29
- date last changed
- 2024-02-13 13:40:50
@article{8580f0d8-e80e-4467-b991-940d3632eb55,
abstract = {{<p>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.</p>}},
author = {{Petersen, M. W. and Perner, A. and Ravn, F. and Sjövall, F. and Møller, M. H.}},
issn = {{0001-5172}},
language = {{eng}},
number = {{1}},
pages = {{6--18}},
publisher = {{Wiley-Blackwell}},
series = {{Acta Anaesthesiologica Scandinavica}},
title = {{Untargeted antifungal therapy in adult patients with complicated intra-abdominal infection : A systematic review}},
url = {{http://dx.doi.org/10.1111/aas.13031}},
doi = {{10.1111/aas.13031}},
volume = {{62}},
year = {{2018}},
}