Indications for selective decontamination of the digestive tract

Controversy exists as to the utility of selective decontamination of the digestive tract (SDD) as a method of infection prevention in critically ill patients. A number of prospective randomly controlled studies and 2 meta-analyses have shown a statistically significant protective effective of SDD against nosocomial infection. Most other SDD trials have shown reductions in nosocomial infections, but these reductions have not been statistically significant. Nearly all SDD studies have shown a less clear mortality benefit, and in no trial has cost-effectiveness been critically evaluated. Side effects of SDD have been limited. Despite nearly a decade of use at some institutions, reports of antimicrobic resistance evolving with SDD and causing disease are infrequent. At this time, SDD cannot be recommended for all intensive care patients in all clinical settings. SDD may be an effective infection prevention method in intensive care units in which there is a high rate of nosocomial pneumonia and/or other infections and in the postoperative period of orthotopic liver transplantation. SDD may also be useful to eliminate resistant gram-negative bacilli colonizing patients who are at high risk for infection sequelae. When SDD is used, periodic surveillance for the emergence of resistant microorganisms is imperative.