A decade of experience with selective decontamination of the digestive tract as prophylaxis for infections in patients in the intensive care unit: what have we learned?

Infection is a frequent and often life-threatening complication in patients treated in intensive care units. Many regimens have been developed to prevent infections in these patients. Recently, a new method of prophylaxis was introduced: selective decontamination of the digestive tract. This paper reviews the results of studies on selective decontamination of the digestive tract with oral, nonabsorbable antimicrobial agents. Most studies showed a positive effect of selective decontamination; a significant decrease in the incidence of nosocomial pneumonia among patients receiving agents for selective decontamination was observed. However, the great differences among the various studies in the incidence of infections among control patients make it difficult to compare the results. The use of antimicrobial agents for selective decontamination had no effect on mortality and in some studies even led to the emergence of resistant microorganisms. The lack of recent data on the incidence, pathogenesis, and epidemiology of infections in patients in intensive care units makes it difficult to recommend routine use of selective decontamination for these patients.