Ventilator-Associated Pneumonia Prevention with Selective Digestive Decontamination

Abstract

Introduction: Selective digestive decontamination (SDD) reduces ventilator-associated pneumonia (VAP) but concerns about antibiotic resistance persist. This review evaluates clinical efficacy and microbiological safety.
Methods: Literature review (2010–2024) of RCTs and large cohort studies comparing SDD (topical + systemic antibiotics) to standard care in adult ICU patients requiring mechanical ventilation >48 hours. Primary outcomes: VAP incidence and 28-day mortality. Secondary: acquisition of multidrug-resistant organisms (MDRO).
Results: Twelve RCTs (n=9,845) demonstrated SDD reduced VAP (OR 0.27, 95% CI 0.22–0.34) and 28-day mortality (OR 0.82, p=0.002). However, SDD increased rectal carriage of third-generation cephalosporin-resistant Enterobacteriaceae (OR 1.84, p=0.01) in some studies. No significant effect on MRSA or VRE.
Discussion: SDD’s mortality benefit is driven by VAP reduction, but ecological impact varies by ICU baseline resistance rates. Long-term use requires microbiological surveillance.
Conclusions: SDD is effective for VAP prevention and mortality reduction in ICUs with low baseline antibiotic resistance. Implementation should be coupled with resistance monitoring and infection control measures.