Selective decontamination of the digestive tract (SDD) is one of the best investigated and most effective infection prevention maneuvers in intensive care. Four meta-analyses of SDD studies have shown that it is highly effective in preventing respiratory tract infections in high-risk patients. Exogenous infections are still important but can only be prevented with conventional hygienic measures. In an environment where methicillin-resistant Staphylococcusaureus (MRSA) is endemic, the regimen of topical antibiotics should be adjusted, to avoid selection of MRSA. The discrepancy between the dramatic reduction in infection rate by SDD and the modest reduction in mortality clearly demonstrates that the underlying disease is a more important determinant of mortality than acquired infections. However, when SDD is fully implemented, i.e. both oral and intestinal decontamination with the polymyxin, tobramycin and amphotericin B regimen in combination with a short-term antibiotic prophylaxis and microbiological surveillance, a 20% reduction in mortality can be achieved. To date there is no evidence that SDD leads to emergence of resistance. The available data justify the use of SDD in high-risk patients.

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