[Can selective decontamination of the digestive tract as a routine procedure on intensive care units be recommended?]

After giving an overview on the epidemiological and microecological background, the applicable drugs, and the necessary microbiological surveillance for Selective Decontamination of the Digestive tract (SDD), the results of 2 new metaanalyses of 22 and 25 individual randomized studies are discussed. A 50%-reduction of the pneumonia incidence results in an only marginal reduction of the mortality rate in the subgroup of topically plus for the first few days systemically treated patients in mixed intensive care units. Facing the weak prognostic relevance of ventilator pneumonia, the reduction of microbial translocation from the lower GI tract as a major goal for SDD is discussed. The chance and the need to confirm a mortality benefit in multicentre trials enrolling large numbers of homogeneous surgical patients are explained. At the present time, SDD as a routine can not (yet) be recommended.