Selective decontamination of the digestive tract: A measure whose time has passed?

Selective decontamination of the digestive tract, using a combination of prophylactic topical and parenteral antibiotics, is a strategy that was developed to reduce the risk of ventilator-associated pneumonia in critically ill patients. Although many of the studies (approximately 40) and four meta-analyses carried out on the subject of selective decontamination of the digestive tract have shown a reduction in the incidence of pneumonia, no clear effects on mortality have been demonstrated, and concerns about overgrowth by, and infections with, micro-organisms resistant to the antibiotics used in this treatment remain, Interestingly, there has recently been an increase in the number of publications on other pharmacological and nonpharmacological methods of infection prevention in mechanically ventilated intensive care unit patients, such as the use of sucralfate for stress ulcer prophylaxis, the modulation of enteral feeding, the suctioning of subglottic secretions and avoidance of the aspiration-prone supine positioning of patients, The results of some of these studies have shown potential benefits. On the basis of a review of the recent literature, the routine use of selective decontamination of the digestive tract is still not justified in intensive care units. Although some of the alternative strategies have shown promising results, more randomized (and double-blind) studies are needed to demonstrate the clinical value of these measures.