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.
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 (email@example.com).
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.
Oostdijk EAN, Kesecioglu J, Schultz MJ, Visser CE, de Jonge E, van Essen EHR, Bernards AT, Purmer I, Brimicombe R, Bergmans D, van Tiel F, Bosch FH, Mascini E, van Griethuysen A, Bindels A, Jansz A, van Steveninck F(L, van der Zwet WC, Fijen JW, Thijsen S, de Jong R, Oudbier J, Raben A, van der Vorm E, Koeman M, Rothbarth P, Rijkeboer A, Gruteke P, Hart H, Peerbooms P, Winsser LJ, van Elsacker-Niele AW, Demmendaal K, Brandenburg A, de Smet AMGA, Bonten MJM. 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.. JAMA. 2017;317(15):1583-1584. doi:10.1001/jama.2017.1282