Antifungal prophylaxis in critically ill patients

We congratulate van Till and colleagues on their review showing that selective decontamination of the digestive tract (SDD) is more effective than single-drug prophylaxis (SAP) in reducing yeast colonisation, infection and mortality [1]. The authors claimed that their review differs from our earlier review, which included paediatric or liver transplant patients. In our review a subgroup analysis was performed in both selected and unselected populations, and demonstrated a significant reduction in yeast carriage and infection in unselected critically ill patients [2]. van Till and colleagues assessed yeast colonisation, lumping together ‘positive yeast cultures obtained from sputum, stool, urine and/or wound ’ [1]. The majority of SDD trials reported positive yeast cultures obtained from surveillance cultures of throat and rectal swabs, whilst the SAP studies mainl

LETTER Open Access Probiotics do not significantly reduce nosocomial pneumonia

Liu and colleagues, in their recent meta-analysis, con-cluded that probiotics were associated with a statistically significant reduction in the incidence of nosocomial pneumonia (NP) (odds ratio = 0.75; 95 % confidence interval = 0.57 to 0.97, P = 0.03) [1]. These results were obtained using the fixed-effect model, ignoring a moder-ate level of heterogeneity (I2 = 46%) [2]. However, we believe that the inclusion criteria, subjects, and interven-tions were different among the included studies, and might have impacted the results. Good practice would therefore be to choose a more conservative analysis; that is, the random-effects model. Using this model, the claimed reduction in NP would have been not significant (odds ratio = 0.70, 95 % confidence interval = 0.46 to 1.05, P = 0.085) (Figure 1). We have already addressed thi