title: For whom should we use selective decontamination of the digestive tract?
abstract: OBJECTIVE
  This review discusses the relevant studies on selective decontamination of the digestive tract (SDD) published between 2009 and mid-2011.
  
  
  RESULTS
  In a multicenter cluster-randomized cross-over study in the Netherlands, SDD and selective oropharyngeal decontamination (SOD) were associated with higher survival at day 28, with a lower incidence of ICU-acquired bacteremia and with less acquisition of respiratory tract colonization with antibiotic resistant pathogens, compared to standard care. A post-hoc analysis of this study suggests that SDD might be more effective in surgical patients and SOD in nonsurgical patients. In a randomized study perioperative use of SDD in patients undergoing gastrointestinal surgery was associated with lower incidences of anastomotic leakages. A Cochrane meta-analysis, not including any of the before mentioned studies, reported a reduction of respiratory tract infections in studies by using topical antibiotics only and higher survival rates when topical antibiotics were combined with parenteral antibiotics.
  
  
  CONCLUSIONS
  Recent studies show that in ICUs with low levels of antibiotic resistance, SDD and SOD improved patient outcome and reduced infections and carriage with antibiotic-resistant pathogens. The effect in settings with higher levels of antibiotic resistance remains to be determined as well as the efficacy of SDD and SOD in specific patient groups.
authors.affiliation: Department of Critical Care, University Medical Center Groningen, The University of Groningen, The Netherlands.
authors.forename: Anne Marie G A
authors.initials: AM
authors.lastname: de Smet
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
authors.forename: Jan A J W
authors.initials: JA
authors.lastname: Kluytmans
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control*; D003666:Decontamination / Q000379:methods*; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D017053:Infection Control / Q000379:methods; D015201:Meta-Analysis as Topic; D009960:Oropharynx / Q000382:microbiology*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents