SELECTIVE DECONTAMINATION OF THE DIGESTIV E-TRACT - CAN IT BE RECOMMENDED AS A ROUTINE MEASURE IN INTENSIVE-CARE UNITS

After giving an overview on the epidemiological and microecological ba ckground, the applicable drugs, and the necessary microbiological surv eillance for Selective Decontamination of the Digestive tract (SDD), t he results of 2 new metaanalyses of 22 and 25 individual randomized st udies are discussed. A 50%-reduction of the pneumonia incidence result s in an only marginal reduction of the mortality rate in the subgroup of topically plus for the first few days systemically treated patients in mixed intensive care units. Facing the weak prognostic relevance o f ventilator pneumonia, the reduction of microbial translocation from the lower GI tract as a major goal for SDD is discussed. The chance an d the need to confirm a mortality benefit in multicentre trials enroll ing large nunbers of homogenous surgical patients are explained. At th e present time, SDD as a routine can not (yet) be recommended.