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Gut sterilization to prevent nosocomial infection.

Nosocomial infections, particularly respiratory tract infections, are common complications that not only lengthen ICU stay but also increase mortality. Since it has been recognized that colonization of the oropharynx and proximal gastrointestinal tract by Gram-negative bacteria is predictive of subsequent pneumonia, attempts have been directed toward sterilizing the upper gastrointestinal tract of pathogenic organisms. Selective decontamination of the digestive tract (SDD) utilizes the administration of topical, nonabsorbable antimicrobials to the gastrointestinal tract and parenteral antibiotics to eradicate the carriage of pathogenic bacteria and, hopefully, improve outcome in critically ill patients. This review of 19 recently published studies indicates that SDD significantly reduces colonization with pathogenic bacteria and nosocomial respiratory tract infections. Reduction in mortality, however, is not a proven effect of SDD.