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Comment & Response
April 18, 2017

Notice of Retraction and Replacement: Oostdijk et al. Effects of Decontamination of the Oropharynx and Intestinal Tract on Antibiotic Resistance in ICUs: A Randomized Clinical Trial. JAMA. 2014;312(14):1429-1437.

Author Affiliations
  • 1Department of Medical Microbiology, University Medical Center Utrecht, Utrecht
  • 2Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht
  • 3Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam
  • 4Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam
  • 5Department of Intensive Care Medicine, Leiden University Medical Center, Leiden
  • 6Department of Medical Microbiology, Leiden University Medical Center, Leiden
  • 7Department of Intensive Care, HagaZiekenhuis, The Hague
  • 8Department of Medical Microbiology, HagaZiekenhuis, The Hague
  • 9Department of Intensive Care, Maastricht University Medical Centre+, Maastricht
  • 10Department of Medical Microbiology, Maastricht University Medical Centre+, Maastricht
  • 11Department of Intensive Care, Rijnstate Hospital, Arnhem
  • 12Laboratory for Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem
  • 13Department of Intensive Care Medicine, Catharina Hospital, Eindhoven
  • 14Laboratory for Medical Microbiology, Laboratories for Pathology and Medical Microbiology, Catharina Hospital, Eindhoven
  • 15Department of Intensive Care, Deventer Hospital, Deventer
  • 16Department of Medical Microbiology, Deventer Hospital, Deventer
  • 17Department of Intensive Care, Diakonessenhuis Utrecht, Utrecht
  • 18Department of Medical Microbiology, Diakonessenhuis Utrecht, Utrecht
  • 19Department of Intensive Care, BovenIJ Hospital, Amsterdam
  • 20Department of Medical Microbiology, Zaans Medical Center, Zaandam
  • 21Department of Intensive Care, Groene Hart Hospital, Gouda
  • 22Department of Medical Microbiology, Groene Hart Hospital, Gouda
  • 23Department of Medical Microbiology, Rijnland Hospital, Leiderdorp
  • 24Department of Intensive Care, Flevo Hospital, Almere
  • 25Department of Medical Microbiology, Flevo Hospital, Almere
  • 26Department of Intensive Care, Sint Lucas Andreas Hospital, Amsterdam
  • 27Department of Medical Microbiology, Sint Lucas Andreas Hospital, Amsterdam
  • 28Department of Intensive Care, Antonius Hospital, Sneek
  • 29Izore, Centre for Infectious Diseases Friesland, Leeuwarden
  • 30Nij Smellinghe Hospital, Drachten
  • 31Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen
  • 32Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
JAMA. 2017;317(15):1583-1584. doi:10.1001/jama.2017.1282

To the Editor In the Original Investigation entitled “Effects of Decontamination of the Oropharynx and Intestinal Tract on Antibiotic Resistance in ICUs: A Randomized Clinical Trial” published in the October 8, 2014, issue of JAMA,1 we inadvertently reported incorrect secondary outcomes. This was a cluster randomized crossover study comparing the ecological effects of selective digestive decontamination (SDD) vs selective oropharyngeal decontamination (SOD) in 16 intensive care units (ICUs) in the Netherlands.

The errors were due to misclassification of the 2 intervention periods of 1 of the 16 ICUs, discovered in the course of rechecking the code in conjunction with an individual patient data meta-analysis. We have corrected the errors and confirmed that there are no other errors after reviewing our original analysis and findings. The correction, though, has changed some of the secondary end points of the study: the previously reported absence of statistically significant differences in day 28 mortality, ICU mortality, hospital mortality, length of stay, and rate of candidemia are now statistically significant, favoring SDD over SOD. Thus, we have requested that the original article be retracted and replaced.

As a result of the mislabeling of interventions in 1 ICU, the flow diagram and Tables 1, 3, 4, and 5 have changed. For day 28 mortality the correct data are 25.7% during SOD and 23.8% during SDD with a corresponding adjusted odds ratio (OR) of 0.850 (95% CI, 0.774-0.933). For ICU mortality the correct data are 20.0% during SOD and 18.4% during SDD with a corresponding adjusted OR of 0.842 (95% CI, 0.759-0.933). For hospital mortality the correct data are 28.2% during SOD and 26.3% during SDD with a corresponding adjusted OR of 0.857 (95% CI, 0.783-0.938). For length of ICU stay the correct data are median of 6 days (IQR, 4-10 days) during SOD and 6 days (IQR, 4-11 days) during SDD (OR, 1.056 [95% CI, 1.014-1.100]). For candidemia the correct data are 1.0% during SOD and 0.5% during SDD with a corresponding OR of 0.47 (95% CI, 0.30-0.75).

The corrections for these errors indicate that the previously reported absence of statistically significant differences in secondary outcomes has been changed and the article now concludes: “Unit-wide application of SDD and SOD was associated with low levels of antibiotic resistance. Compared with SOD, SDD was associated with lower mortality, reduced length of stay, lower rates of ICU-acquired bacteremia and candidemia, and lower prevalence of rectal carriage of antibiotic-resistant gram-negative bacteria, but a more pronounced gradual increase in aminoglycoside-resistant gram-negative bacteria.”

We deeply regret this error as well as the confusion caused to JAMA, readers, and potentially to physicians. The original article has been corrected. An additional online supplement has been added that includes a version of the original article with the errors highlighted and a version of the replacement article with the corrections highlighted.

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Article Information

Corresponding Author: Evelien A. N. Oostdijk, MD, PhD, Department of Medical Microbiology, University Medical Center Utrecht, G04.517, PO Box 85500, 3508 GA Utrecht, the Netherlands (e.a.n.oostdijk@umcutrecht.nl).

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Kesecioglu reported receiving personal fees from Becton Dickinson. No other authors reported disclosures.

References
1.
Oostdijk  EA, Kesecioglu  J, Schultz  MJ,  et al.  Effects of decontamination of the oropharynx and intestinal tract on antibiotic resistance in ICUs: a randomized clinical trial.  JAMA. 2014;312(14):1429-1437.PubMedArticle
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