Selective decontamination of the digestive tract

The aim of this article is to review relevant studies on the topic of selective decontamination of the digestive tract published in 2006 and 2007.

The only recently published randomized controlled selective decontamination of the digestive tract study failed to demonstrate a benefit of selective decontamination on survival among trauma patients. In fact, two new meta-analyses of selective decontamination of the digestive tract studies were presented: one demonstrated reduced incidences of Gram-negative bacteraemia; in the other no reduction in fungaemia was found. Although selective decontamination of the digestive tract has been associated with increased selection of methicillin-resistant Staphylococcus aureus (MRSA), transmission of MRSA was controlled in a Spanish unit when using selective decontamination in combination with topical vancomycin. Several randomized studies and one meta-analysis suggest that oropharyngeal decontamination with antiseptics is also highly effective in preventing respiratory tract infection in critically ill patients.

The evidence that selective decontamination of the digestive tract improves patient outcome in mixed ICU patients is still based upon meta-analysis and two single centre studies in MRSA-naïve settings. Larger and preferably multicentre studies are needed to confirm these observations. Further remaining questions are whether oropharyngeal decontamination alone is as effective as the full selective decontamination of the digestive tract regimen and whether selective decontamination could be applied successfully in settings with high levels of antibiotic resistance.