• Wittekamp Bastiaan H J BHJ Department of Intensive Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. b.h.j.wittekamp@umcutrecht.nl., Oostdijk Evelien A N EAN Department of Intensive Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Brian H Cuthbertson, Christian Brun-Buisson, and Bonten Marc J M MJM 0000-0002-9095-9201 Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Nether.
• Department of Intensive Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. b.h.j.wittekamp@umcutrecht.nl.
• Intensive Care Med. 2020 Feb 1; 46 (2): 343-349.

AbstractSelective decontamination of the digestive tract (SDD) is an infection prevention measure for intensive care unit (ICU) patients that was proposed more than 30 years ago, and that is currently considered standard of care in the Netherlands, but only used sporadically in ICUs in other countries. In this narrative review, we first describe the rationale of the individual components of SDD and then review the evidence base for patient-centered outcomes, where we distinguish ICUs with low prevalence of antibiotic resistance from ICUs with moderate-high prevalence of resistance. In settings with low prevalence of antibiotic resistance, SDD has been associated with improved patient outcome in three cluster-randomized studies. These benefits were not confirmed in a large international cluster-randomized study in settings with moderate-to-high prevalence of antibiotic resistance. There is no evidence that SDD increases antibiotic resistance. We end with future directions for research.

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