Should We Decontaminate the Gut in the ICU?

Selective decontamination of the digestive tract (SDD) involves applying topical antimicrobials to the oropharynx and gut, typically accompanied by a short course of intravenous (IV) antibiotics, to prevent hospital-acquired infections in patients receiving mechanical ventilation (Figure 1). Although variably used for over 40 years, the practice hasn’t widely caught on, predominantly due to the fear that it promotes antimicrobial resistance, alongside uncertain clinical benefit.

This updated meta-analysis now encompasses 32 randomized, controlled trials comparing SDD with standard care among nearly 28,000 adults receiving mechanical ventilation in the ICU; it includes the recently completed multinational SuDDICU trial.