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Presently, antimicrobial methods and control agents to eradicate biofilm pathogens are generally unsuccessful [ 13, 22].
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Sterilization is associated with the total absence of viable microorganisms, which refers to an absolute condition and assures the greatest safety margin than any other antimicrobial method [ 7, 8].
Nevertheless, despite the usefulness of the previous research, the in vivo scenario can differ from the in vitro situation, and this must be taken into account when proposing UV irradiation as an antimicrobial method for titanium implants.
The VAP-IP benchmark derived here is 22.1%95%5% confidence interval; 95% CI; 19.2 to 25.5; tau2 0.34) whereas the mean VAP-IP of control groups from studies of SDD and of non-antimicrobial methods, is 35.7 (29.7 to 41.8; tau2 0.63) versus 20.4 (17.2 to 24.0; tau2 0.41), respectively (P < 0.001).
Nine reviews were used to source 45 observational (benchmark) groups and 137 component (control and intervention) groups of studies of SDD and studies of three non-antimicrobial methods of VAP prevention.
The mean VAP-IP (95% CI) of intervention groups is 16.0 (12.6 to 20.3; tand 0.59) and 17.1 (14.2 to 20.3; tau2 0.35) for SDD studies versus studies of non-antimicrobial methods, respectively.
Selective digestive decontamination (SDD) appears to have a more compelling evidence base than non-antimicrobial methods for the prevention of ventilator associated pneumonia (VAP).
The studies of non-antimicrobial methods more often attained majority quality scores than did studies of SDD in the respective systematic reviews (P = 0.006).
By contrast, the mean VAP-IP of 35 intervention groups studies of non-antimicrobial methods versus 34 SDD intervention groups are each within six percentage points of the benchmark.
Potential confounders include enhanced screening activity, change in laboratory methods and antimicrobial consumption.
All microorganisms were identified by using standard methods, and antimicrobial susceptibility was determined according to Clinical and Laboratory Standards Institute (CLSI) recommendations.
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