Selective gut decontamination in intensive care and surgical practice: where are we?

Selective decontamination of the digestive tract (SDD) has been widely studied in the intensive care setting. Despite the publication of more than 50 controlled trials, it remains a controversial subject, with widely disparate views on the role of SDD. This article reviews the use of SDD primarily by examining the areas of controversy. The published data seem to show clear evidence that SDD can reduce acquired infection during intensive care. Most individual studies have shown no effect on mortality, but meta-analyses suggest a 10% overall reduction in mortality. Despite the large number of publications to date, there remain several aspects worthy of further study.