This study evaluated the effectiveness of selective decontamination of the digestive tract and oropharynx in decreasing the incidence of ventilator-associated pneumonia and, thus, mortality in the ICU. Nosocomial infections have significant negative effects on morbidity, mortality, and cost of hospitalization in the ICU.

The authors state that previous studies' lack of either statistical significance or generalizability, as well as concern about increasing antibiotic resistance in organisms, has made the routine use of these methods controversial. Their study aimed to correct these shortcomings.

In this study, 5,939 patients were enrolled from 13 ICUs throughout the Netherlands between May 2004 and July 2006. Inclusion criteria included anticipated mechanical ventilation of more than two days' duration or an expected ICU stay of more than three days. Patients were divided into three groups: 1,990 received standard care, 1,904 received oropharyngeal decontamination, and 2,045 received digestive tract decontamination. The oropharyngeal group had topical antibiotics applied in the oropharynx, and the digestive tract group had topical antibiotics applied in the oropharynx and the gastrointestinal tract in addition to IV antibiotics administered during the first four days of the ICU stay. The mortality rate at 28 days was the study's end point.

The mortality rates were 13% and 11% lower in the selective digestive tract decontamination and selective oropharyngeal decontamination groups, respectively, than in the standard care group. Given the intervention groups' similar outcomes, the authors recommend that selective oropharyngeal decontamination be used rather than selective decontamination of the digestive tract because the former carries less risk of overexposure to antibiotics and a consequent development of antibiotic- resistant organisms.

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