[Current aspects and future developments in infection prevention in intensive care units]

The high frequency of nosocomial infections in intensive care units can be reduced in two different ways. Methods which impede the colonization of the patient with pathogenic microorganisms are of primary interest. Replacement of invasive techniques of monitoring and treatment by alternative non-invasive methods will help to prevent infections caused or favoured by those techniques. The concept of selective decontamination of the digestive tract (SDD) is reported to reduce nosocomial infections considerably but needs further clinical evaluation. Furthermore, there is a danger of selecting highly resistant strains by this regimen. A second approach to prevention of infections is improvement of these patients' severely impaired immune defense. The prophylactic use of intravenous immunoglobulins has produced encouraging results, but the indication, dosage and timing of the medication, and a cost-benefit analysis, need further careful consideration. So far, no conclusive clinical studies have been reported on stimulation of cellular immune defense. Finally, improved information on immunodeficiency induced by drugs frequently used in intensive care is an urgent necessity.