title: Selective decontamination of the digestive tract and oropharynx: after 30 years of debate is the definitive answer in sight?
abstract: OBJECTIVE
  Selective digestive or oropharyngeal decontamination has been being used as a means to prevent infections and death in intensive care patients for the past 30 years. It remains controversial and its use is limited. In this review, we summarize the recently published data on efficacy of selective decontamination and effects on antibiotic resistances.
  
  
  RESULTS
  The most recent meta-analysis shows a reduced mortality when selective digestive or oropharyngeal decontamination are compared with either standard care or oropharyngeal chlorhexidine. Selective decontamination is associated with reduced bacteraemia, and although this effect is greater with selective digestive decontamination compared with selective oropharyngeal decontamination, there is not a mortality difference between these two interventions. Reanalysis of infection data suggests, however, that selective decontamination may also have effects on concurrent control groups. Current evidence generally shows that antibiotic resistance is decreased although much of these data come from the Netherlands (an area with low endemic antibiotic resistance rates). There are currently two huge cluster randomized clinical trials, one in early recruitment, one in development, which will hopefully provide definitive answers in the years to come.
  
  
  CONCLUSIONS
  Current evidence suggests that selective decontamination reduces mortality without increasing antibiotic resistances; this will be tested again in two huge international trials.
authors.affiliation: aIntensive Care Unit, Royal Alexandra Hospital, Paisley, UK bDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Price
authors.forename: Brian H
authors.initials: BH
authors.lastname: Cuthbertson
mesh_terms: D000284:Administration, Oral; D000891:Anti-Infective Agents, Local / Q000009:adverse effects / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D041981:Gastrointestinal Tract / Q000382:microbiology* / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D009960:Oropharynx / Q000382:microbiology* / Q000503:physiopathology; D017410:Practice Guidelines as Topic
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine