Selective decontamination of the digestive tract: an update of the evidence

Selective decontamination of the digestive tract has been proven to prevent severe infections and to reduce mortality in critically ill patients. Historical arguments against its use, like the development of bacterial resistance and the absence of influence on mortality, have not been confirmed. Recent clinical trials designed to evaluate these variables and meta-analyses showed remarkable reductions in the incidence of resistant bacteria and a significant beneficial effect on survival. This review will update the evidence on the efficacy of selective decontamination of the digestive tract, and the issue of emergence of resistance, using data from randomized controlled trials and meta-analyses.