title: Selective digestive tract decontamination in critically ill patients.
abstract: BACKGROUND
  Selective decontamination of the digestive tract (SDD) has been proposed to prevent endogenous and exogenous infections and to reduce mortality in critically ill patients. Although the efficacy of SDD has been confirmed by randomized controlled trials (RCTs) and systematic reviews, SDD has been the subject of intense controversy, based mainly on an insufficient evidence of efficacy and on concerns about resistance.
  
  
  METHODS
  This article reviews the philosophy, the current evidence on the efficacy of SDD and the issue of emergence of resistance. All SDD RCTs were searched using Embase and Medline, with no restriction of language, gender or age. Personal archives were also explored, including abstracts from major scientific meetings; references in papers and published meta-analyses on SDD were crosschecked. Up-to-date evidence of the impact of SDD on carriage, infections and mortality is presented, and the efficacy of SDD in selected patient groups was investigated, along with the problem of the emergence of resistance.
  
  
  CONCLUSIONS
  SDD significantly reduces the number of infections of the lower respiratory tract and bloodstream, multiple organ failure and mortality. It also controls resistance, particularly when the full protocol of parenteral and enteral antimicrobials is used.
authors.affiliation: Department of Emergency, Unit of Anaesthesia and Intensive Care, Presidio Ospedaliero di Gorizia, Via Fatebenefratelli 34, 34170 Gorizia, Italy. lucianosilvestri@yahoo.it
authors.forename: Luciano
authors.initials: L
authors.lastname: Silvestri
authors.forename: Hendrick K F
authors.initials: HK
authors.lastname: van Saene
authors.forename: Andy J
authors.initials: AJ
authors.lastname: Petros
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D016638:Critical Illness; D003666:Decontamination / Q000191:economics / Q000379:methods*; D024881:Drug Resistance, Bacterial; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods*
chemical_list: D000890:Anti-Infective Agents