Selective decontamination of digestive tract in intensive care patients leads to fewer in-hospital deaths

Question. Does selective decontamination of the digestive tract (SDD) of people in intensive care (ICU) reduce mortality and infection by drug-resistant bacteria? Study design. Unblinded randomised controlled trial. Main results. In the ICU, SDD lowered mortality compared with usual care (69 deaths vs. 107 deaths; RR 0.65 95% CI 0.49-0.85, p=0.002). SDD decreased overall hospital mortality compared with usual care (113 vs. 146; p = 0.02). Acquired infections of resistant Gram-negative aerobic bacteria were lower for SDD compared with usual care (16% vs. 26%, RR 0.61, 95% CI 0.46-0.81). There were no differences in vancomycin-resistant enterococcus infections between groups (p = 1.0). No methicillin-resistant S. aureus were found in either group. The usual care unit was colonised with significantly more ceftazidime-resistant enterobacteriaceae compared with the SDD unit (p < 0.0001). This was the only significant difference in bacterial colonisation between units. Authors' conclusions. SDD decreased colonisation with vancomycin-resistant enterococcus, and reduced in-hospital mortality.