Commentary

Selective decontamination of the digestive tract reduces mortality in critically ill patients

Marcus J Schultz^1*, Evert de Jonge¹ and Jozef Kesecioglu²

• * Corresponding author: Marcus J Schultz m.j.schultz@amc.uva.nl

Author Affiliations

¹ Internist-Intensivist, Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, The Netherlands

² Anaesthesiologist-Intensivist, Division of Perioperative Care, Cardiopulmonary Intensive Care and Neuro Intensive Care, University Medical Center, Utrecht, The Netherlands

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Critical Care 2003, 7:107-110 doi:10.1186/cc1873

Published: 24 January 2003

Abstract

Several emotional responses may be invoked in critical care physicians when confronted with selective decontamination of the digestive tract (SDD). Although recent meta-analyses have shown that the use of SDD reduces the occurrence of ventilator-associated pneumonia and improves ICU survival, the effectiveness of SDD has remained controversial. We recently concluded a large randomized, controlled trial on the use of SDD that showed improved survival of ICU patients treated with SDD. A second concern regarding use of SDD has been the fear for the emergence of antimicrobial resistance. Interestingly, a recently published study did not confirm this fear, and our recently finished study even demonstrated a decline in colonization with P. aeruginosa and enterobacteriaceae that were resistant against tobramycin, ceftazidime, imipenem and ciprofloxacin. The hopes are that this study will at long last end the debate about the efficacy and safety of SDD in critically ill patients.