Selective decontamination in intensive care practice: a review of clinical experience

Acquired infection is a common problem in intensive care and in a general ICU the infection rate can exceed 80% in patients ventilated beyond 5 days. SDD, adapted from regimes used in neutropenic patients, was first introduced to the ICU situation in Groningen. This article reviews 10 published trials of SDD in ICU. The trial designs vary but all show a significant reduction in both colonisation rates and acquired infection rates. Infection rates were reduced from 10%-78% to 3%-10% in the SDD treated groups. Of the 10 trials 2 showed an overall reduction in mortality 2 showed a reduction in infection-related mortality and 1 showed a reduction in mortality amongst trauma patients. Although further evaluation of trials is required SDD now appears to be of proven efficacy in certain groups of high risk patients within ICU.