Methods of preventing bacterial sepsis and wound complications for liver transplantation

Kurinchi Selvan Gurusamy; Yogesh Kumar; Brian R Davidson

doi:10.1002/14651858.CD006660.pub2

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Figure 1

Figure 01

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Analysis 1.1

Comparison 1 Selective bowel decontamination versus control, Outcome 1 Mortality due to infective cause.

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Analysis 1.2

Comparison 1 Selective bowel decontamination versus control, Outcome 2 Wound infection.

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Analysis 1.3

Comparison 1 Selective bowel decontamination versus control, Outcome 3 Abdominal infection.

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Analysis 1.4

Comparison 1 Selective bowel decontamination versus control, Outcome 4 Cholangitis.

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Analysis 1.5

Comparison 1 Selective bowel decontamination versus control, Outcome 5 Chest infection.

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Analysis 1.6

Comparison 1 Selective bowel decontamination versus control, Outcome 6 Urinary infection.

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Analysis 1.7

Comparison 1 Selective bowel decontamination versus control, Outcome 7 Intravascular catheter infection.

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Analysis 1.8

Comparison 1 Selective bowel decontamination versus control, Outcome 8 Bacteraemia.

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Analysis 1.9

Comparison 1 Selective bowel decontamination versus control, Outcome 9 Gram negative bacteraemia.

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Analysis 1.10

Comparison 1 Selective bowel decontamination versus control, Outcome 10 Septicaemia.

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Analysis 1.11

Comparison 1 Selective bowel decontamination versus control, Outcome 11 Patients with any bacterial infection.

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Analysis 1.12

Comparison 1 Selective bowel decontamination versus control, Outcome 12 Patients with any gram‐negative bacterial infection.

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Analysis 1.13

Comparison 1 Selective bowel decontamination versus control, Outcome 13 Pseudomembranous colitis.

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Analysis 1.14

Comparison 1 Selective bowel decontamination versus control, Outcome 14 Hospital stay.

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Analysis 2.1

Comparison 2 Selective bowel decontamination versus lactobacillus with fibres, Outcome 1 Wound infection.

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Analysis 2.2

Comparison 2 Selective bowel decontamination versus lactobacillus with fibres, Outcome 2 Cholangitis.

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Analysis 2.3

Comparison 2 Selective bowel decontamination versus lactobacillus with fibres, Outcome 3 Chest infection.

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Analysis 2.4

Comparison 2 Selective bowel decontamination versus lactobacillus with fibres, Outcome 4 Urinary infection.

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Analysis 2.5

Comparison 2 Selective bowel decontamination versus lactobacillus with fibres, Outcome 5 Septicaemia.

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Analysis 2.6

Comparison 2 Selective bowel decontamination versus lactobacillus with fibres, Outcome 6 Other infection.

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Analysis 2.7

Comparison 2 Selective bowel decontamination versus lactobacillus with fibres, Outcome 7 Patients with any bacterial infection.

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Analysis 2.8

Comparison 2 Selective bowel decontamination versus lactobacillus with fibres, Outcome 8 ITU stay (days).

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Analysis 2.9

Comparison 2 Selective bowel decontamination versus lactobacillus with fibres, Outcome 9 Hospital stay (days).

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Analysis 3.1

Comparison 3 Selective bowel decontamination versus fibres, Outcome 1 Wound infection.

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Analysis 3.2

Comparison 3 Selective bowel decontamination versus fibres, Outcome 2 Cholangitis.

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Analysis 3.3

Comparison 3 Selective bowel decontamination versus fibres, Outcome 3 Chest infection.

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Analysis 3.4

Comparison 3 Selective bowel decontamination versus fibres, Outcome 4 Urinary infection.

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Analysis 3.5

Comparison 3 Selective bowel decontamination versus fibres, Outcome 5 Septicaemia.

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Analysis 3.6

Comparison 3 Selective bowel decontamination versus fibres, Outcome 6 Other infection.

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Analysis 3.7

Comparison 3 Selective bowel decontamination versus fibres, Outcome 7 Patients with any bacterial infection.

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Analysis 3.8

Comparison 3 Selective bowel decontamination versus fibres, Outcome 8 ITU stay (days).

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Analysis 3.9

Comparison 3 Selective bowel decontamination versus fibres, Outcome 9 Hospital stay (days).

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Analysis 4.1

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 1 Wound infection.

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Analysis 4.2

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 2 Cholangitis.

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Analysis 4.3

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 3 Chest infection.

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Analysis 4.4

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 4 Urinary infection.

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Analysis 4.5

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 5 Septicaemia.

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Analysis 4.6

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 6 Other infection.

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Analysis 4.7

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 7 Patients with any bacterial infection.

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Analysis 4.8

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 8 Patients with any gram‐negative bacterial infection.

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Analysis 4.9

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 9 Rejection.

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Analysis 4.10

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 10 Re‐transplantation.

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Analysis 4.11

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 11 Abdominal cramps.

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Analysis 4.12

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 12 Diarhhoea.

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Analysis 4.13

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 13 ITU stay (days).

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Analysis 4.14

Comparison 4 Lactobacillus with fibres versus fibres, Outcome 14 Hospital stay (days).

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Analysis 5.1

Comparison 5 Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus control, Outcome 1 Mortality due to infective cause.

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Analysis 5.2

Comparison 5 Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus control, Outcome 2 Patients with any bacterial infection.

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Analysis 5.3

Comparison 5 Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus control, Outcome 3 Patients with any gram‐negative bacterial infection.

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Analysis 5.4

Comparison 5 Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus control, Outcome 4 Rejection.

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Analysis 5.5

Comparison 5 Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus control, Outcome 5 Re‐transplantation.

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Analysis 6.1

Comparison 6 Granulocyte‐colony stimulating factor (G‐CSF) 100 microgram versus control, Outcome 1 Mortality due to infective cause.

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Analysis 6.2

Comparison 6 Granulocyte‐colony stimulating factor (G‐CSF) 100 microgram versus control, Outcome 2 Patients with any bacterial infection.

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Analysis 6.3

Comparison 6 Granulocyte‐colony stimulating factor (G‐CSF) 100 microgram versus control, Outcome 3 Patients with any gram‐negative bacterial infection.

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Analysis 6.4

Comparison 6 Granulocyte‐colony stimulating factor (G‐CSF) 100 microgram versus control, Outcome 4 Rejection.

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Analysis 6.5

Comparison 6 Granulocyte‐colony stimulating factor (G‐CSF) 100 microgram versus control, Outcome 5 Re‐transplantation.

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Analysis 7.1

Comparison 7 Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus G‐CSF 100 microgram, Outcome 1 Mortality due to infective cause.

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Analysis 7.2

Comparison 7 Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus G‐CSF 100 microgram, Outcome 2 Patients with any bacterial infection.

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Analysis 7.3

Comparison 7 Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus G‐CSF 100 microgram, Outcome 3 Patients with any gram‐negative bacterial infection.

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Analysis 7.4

Comparison 7 Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus G‐CSF 100 microgram, Outcome 4 Rejection.

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Analysis 7.5

Comparison 7 Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus G‐CSF 100 microgram, Outcome 5 Re‐transplantation.

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Table 1. Reasons for post‐randomisation exclusion

Study	Intervention	Control	Reasons (all groups)	Number for analysis	Drop‐out percentage
Arnow 1996	12	5	17 Died before transplantation ‐ 9. Withdrew without explanation ‐ 2. Severe gastrointestinal symptoms ‐ 4. Alternative regimen of peri‐operative prophylaxis ‐ 2.	69	19.8%
Bion 1994	6 Died before transplantation ‐ 5. Disliked the taste of the suspension ‐ 1.	1 Died before transplantation ‐ 1.	‐	52	11.9%
Hellinger 2002	0	0	‐	80	0%
Rayes 2002	Group not stated.	Group not stated.	10 Re‐laparotomies within the first two postoperative days ‐ 6. Early ileus ‐ 2. Acute renal failure ‐ 2.	94	9.6%
Rayes 2005	0	0	‐	66	0%
Winston 1999	Group not stated.	Group not stated.	9 Investigator decision ‐ 2. Patient decision ‐ 7.	194	3.5%
Zwaveling 2002	Group not stated.	Group not stated.	31 Died before transplantation ‐ 5. Prescription of norfloxacin for spontaneous bacterial peritonitis ‐ 4. Lack of motivation ‐ 7. Adverse effects ‐ 7. Miscellaneous ‐ 8.	58	34.8%

Table 1. Reasons for post‐randomisation exclusion

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Table 2. Summary of meta‐analysis

Outcome	SBD versus control	SBD versus control (risk difference)	SBD versus lactobacillus and fibres	SBD versus fibres	lactobacillus and fibres versus fibres	G‐CSF 300 versus control	G‐CSF 100 versus control	G‐CSF 300 versus 100 microgram
Mortality due to infective cause	0.29 [0.01, 5.77]	‐0.02 [‐0.08, 0.05]	‐	‐	‐	1.61 [0.54, 4.80]	0.89 [0.25, 3.17]	1.81 [0.56, 5.86]
Wound infection	0.83 [0.48, 1.42]	0.83 [0.48, 1.42]	2.91 [0.12, 68.81]	3.00 [0.13, 71.00]	0.33 [0.01, 7.90]	‐	‐	‐
Abdominal infection	0.80 [0.45, 1.41]	‐0.04 [‐0.14, 0.06]	‐	‐	‐	‐	‐	‐
Cholangitis	1.04 [0.56, 1.96]	0.01 [‐0.08, 0.09]	4.84 [1.15, 20.35]	1.25 [0.57, 2.75]	0.27 [0.07, 1.02]	‐	‐	‐
Urinary infection	0.61 [0.29, 1.31]	‐0.02 [‐0.08, 0.04]	Not estimable	0.14 [0.01, 2.66]	0.10 [0.02, 0.50]	‐	‐	‐
Intravascular catheter infection	0.78 [0.25, 2.42]	‐0.02 [‐0.12, 0.08]	‐	‐	‐	‐	‐	‐
Bacteraemia	0.88 [0.43, 1.83]	‐0.01 [‐0.08, 0.06]	‐	‐	‐	‐	‐	‐
Gram negative bacteraemia	1.15 [0.26, 5.14]	0.00 [‐0.05, 0.06]	‐	‐	‐	‐	‐	‐
Septicaemia	1.16 [0.36, 3.70]	0.00 [‐0.07, 0.07]	6.79 [0.36, 126.24]	7.00 [0.38, 130.26]	Not estimable	‐	‐	‐
Other infection	‐	‐	2.91 [0.32, 26.46]	1.50 [0.27, 8.38]	0.52 [0.05, 5.41]	‐	‐	‐
Patients with any bacterial infection	0.82 [0.48, 1.41]	‐0.08 [‐0.25, 0.09]	3.63 [1.36, 9.74]	1.36 [0.75, 2.50]	0.18 [0.03, 1.17]	1.43 [0.73, 2.82]	0.65 [0.27, 1.54]	2.21 [0.97, 5.05]
Patients with any gram‐negative bacterial infection	0.72 [0.33, 1.59]	‐0.04 [‐0.15, 0.06]	‐	‐	0.07 [0.01, 0.48]	1.31 [0.50, 3.41]	0.79 [0.27, 2.37]	1.65 [0.57, 4.77]
Rejection	Not relevant.	Not relevant.	‐	‐	Not relevant.	2.09 [1.09, 4.00]	1.41 [0.69, 2.88]	1.48 [0.82, 2.65]
Re‐transplantation	Not relevant.	Not relevant.	‐	‐	Not relevant.	1.38 [0.44, 4.29]	0.89 [0.25, 3.17]	1.55 [0.46, 5.22]
Pseudomembranous colitis	2.32 [0.22, 24.61]	0.03 [‐0.05, 0.12]	‐	‐	‐	‐	‐	‐
Abdominal cramps	Not relevant.	Not relevant.	‐	‐	0.83 [0.28, 2.46]	‐	‐	‐
Diarrhoea	Not relevant.	Not relevant.	‐	‐	0.75 [0.18, 3.09]	‐	‐	‐
ITU stay (days)	‐	‐	4.00 [‐0.83, 8.83]	2.20 [‐3.68, 8.08]	‐1.41 [‐2.09, ‐0.73]	‐	‐	‐
Hospital stay (days)	0.60 [‐7.71, 8.91]	‐	4.00 [3.14, 4.86]	3.00 [2.05, 3.95]	‐0.48 [‐1.31, 0.34]	‐	‐	‐
Risk ratio for all outcomes except intensive therapy unit (ITU) stay and hospital stay where weighted mean difference was used. All reported in the form effect size [95% confidence intervals]. SBD =selective bowel decontamination G‐SCF = granulocyte‐colony stimulating factor

Table 2. Summary of meta‐analysis

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Comparison 1. Selective bowel decontamination versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality due to infective cause Show forest plot	2	132	Risk Ratio (M‐H, Fixed, 95% CI)	0.29 [0.01, 5.77]

2 Wound infection Show forest plot	4	259	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.48, 1.42]

3 Abdominal infection Show forest plot	3	207	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.45, 1.41]

4 Cholangitis Show forest plot	3	190	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.56, 1.96]

5 Chest infection Show forest plot	4	259	Risk Ratio (M‐H, Random, 95% CI)	0.48 [0.08, 2.83]

6 Urinary infection Show forest plot	4	259	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.29, 1.31]

7 Intravascular catheter infection Show forest plot	2	127	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.25, 2.42]

8 Bacteraemia Show forest plot	4	259	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.43, 1.83]

9 Gram negative bacteraemia Show forest plot	3	201	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.26, 5.14]

10 Septicaemia Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.36, 3.70]

11 Patients with any bacterial infection Show forest plot	3	201	Risk Ratio (M‐H, Random, 95% CI)	0.82 [0.48, 1.41]

12 Patients with any gram‐negative bacterial infection Show forest plot	2	149	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.33, 1.59]

13 Pseudomembranous colitis Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	2.32 [0.22, 24.61]

14 Hospital stay Show forest plot	1	52	Mean Difference (IV, Fixed, 95% CI)	0.60 [‐7.71, 8.91]

Comparison 1. Selective bowel decontamination versus control

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Comparison 2. Selective bowel decontamination versus lactobacillus with fibres

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Wound infection Show forest plot	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	2.91 [0.12, 68.81]

2 Cholangitis Show forest plot	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	4.84 [1.15, 20.35]

3 Chest infection Show forest plot	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	5.81 [0.74, 45.54]

4 Urinary infection Show forest plot	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

5 Septicaemia Show forest plot	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	6.79 [0.36, 126.24]

6 Other infection Show forest plot	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	2.91 [0.32, 26.46]

7 Patients with any bacterial infection Show forest plot	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	3.63 [1.36, 9.74]

8 ITU stay (days) Show forest plot	1	63	Mean Difference (IV, Fixed, 95% CI)	4.0 [‐0.83, 8.83]

9 Hospital stay (days) Show forest plot	1	63	Mean Difference (IV, Fixed, 95% CI)	4.0 [3.14, 4.86]

Comparison 2. Selective bowel decontamination versus lactobacillus with fibres

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Comparison 3. Selective bowel decontamination versus fibres

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Wound infection Show forest plot	1	64	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 71.00]

2 Cholangitis Show forest plot	1	64	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.57, 2.75]

3 Chest infection Show forest plot	1	64	Risk Ratio (M‐H, Fixed, 95% CI)	1.5 [0.47, 4.82]

4 Urinary infection Show forest plot	1	64	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.01, 2.66]

5 Septicaemia Show forest plot	1	64	Risk Ratio (M‐H, Fixed, 95% CI)	7.0 [0.38, 130.26]

6 Other infection Show forest plot	1	64	Risk Ratio (M‐H, Fixed, 95% CI)	1.5 [0.27, 8.38]

7 Patients with any bacterial infection Show forest plot	1	64	Risk Ratio (M‐H, Fixed, 95% CI)	1.36 [0.75, 2.50]

8 ITU stay (days) Show forest plot	1	64	Mean Difference (IV, Fixed, 95% CI)	2.20 [‐3.68, 8.08]

9 Hospital stay (days) Show forest plot	1	64	Mean Difference (IV, Fixed, 95% CI)	3.0 [2.05, 3.95]

Comparison 3. Selective bowel decontamination versus fibres

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Comparison 4. Lactobacillus with fibres versus fibres

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Wound infection Show forest plot	2	129	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.90]

2 Cholangitis Show forest plot	2	129	Risk Ratio (M‐H, Fixed, 95% CI)	0.27 [0.07, 1.02]

3 Chest infection Show forest plot	2	129	Risk Ratio (M‐H, Fixed, 95% CI)	0.28 [0.05, 1.63]

4 Urinary infection Show forest plot	2	129	Risk Ratio (M‐H, Fixed, 95% CI)	0.10 [0.02, 0.50]

5 Septicaemia Show forest plot	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

6 Other infection Show forest plot	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	0.52 [0.05, 5.41]

7 Patients with any bacterial infection Show forest plot	2	129	Risk Ratio (M‐H, Random, 95% CI)	0.18 [0.03, 1.17]

8 Patients with any gram‐negative bacterial infection Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	0.07 [0.01, 0.48]

9 Rejection Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.32, 2.28]

10 Re‐transplantation Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.90]

11 Abdominal cramps Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.28, 2.46]

12 Diarhhoea Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.18, 3.09]

13 ITU stay (days) Show forest plot	2	129	Mean Difference (IV, Fixed, 95% CI)	‐1.41 [‐2.09, ‐0.73]

14 Hospital stay (days) Show forest plot	2	129	Mean Difference (IV, Fixed, 95% CI)	‐0.48 [‐1.31, 0.34]

Comparison 4. Lactobacillus with fibres versus fibres

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Comparison 5. Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality due to infective cause Show forest plot	1	131	Risk Ratio (M‐H, Fixed, 95% CI)	1.61 [0.54, 4.80]

2 Patients with any bacterial infection Show forest plot	1	131	Risk Ratio (M‐H, Fixed, 95% CI)	1.43 [0.73, 2.82]

3 Patients with any gram‐negative bacterial infection Show forest plot	1	131	Risk Ratio (M‐H, Fixed, 95% CI)	1.31 [0.50, 3.41]

4 Rejection Show forest plot	1	131	Risk Ratio (M‐H, Fixed, 95% CI)	2.09 [1.09, 4.00]

5 Re‐transplantation Show forest plot	1	131	Risk Ratio (M‐H, Fixed, 95% CI)	1.38 [0.44, 4.29]

Comparison 5. Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus control

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Comparison 6. Granulocyte‐colony stimulating factor (G‐CSF) 100 microgram versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality due to infective cause Show forest plot	1	133	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.25, 3.17]

2 Patients with any bacterial infection Show forest plot	1	133	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.27, 1.54]

3 Patients with any gram‐negative bacterial infection Show forest plot	1	133	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.27, 2.37]

4 Rejection Show forest plot	1	133	Risk Ratio (M‐H, Fixed, 95% CI)	1.41 [0.69, 2.88]

5 Re‐transplantation Show forest plot	1	133	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.25, 3.17]

Comparison 6. Granulocyte‐colony stimulating factor (G‐CSF) 100 microgram versus control

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Comparison 7. Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus G‐CSF 100 microgram

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality due to infective cause Show forest plot	1	124	Risk Ratio (M‐H, Fixed, 95% CI)	1.81 [0.56, 5.86]

2 Patients with any bacterial infection Show forest plot	1	124	Risk Ratio (M‐H, Fixed, 95% CI)	2.21 [0.97, 5.05]

3 Patients with any gram‐negative bacterial infection Show forest plot	1	124	Risk Ratio (M‐H, Fixed, 95% CI)	1.65 [0.57, 4.77]

4 Rejection Show forest plot	1	124	Risk Ratio (M‐H, Fixed, 95% CI)	1.48 [0.82, 2.65]

5 Re‐transplantation Show forest plot	1	124	Risk Ratio (M‐H, Fixed, 95% CI)	1.55 [0.46, 5.22]

Comparison 7. Granulocyte‐colony stimulating factor (G‐CSF) 300 microgram versus G‐CSF 100 microgram

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Comparison 8. Early enteral feeding versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Patients with any bacterial infection	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Hospital stay (days)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 8. Early enteral feeding versus control

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