Prevention of ventilator-associated pneumonia by selective decontamination of the digestive tract.

We read with interest the review entitled ‘‘Evidence on measures for the prevention of ventilator-associated pneumonia’’ by LORENTE et al. [1]. We enjoyed the paper as it is comprehensive and based on an appropriate design. In particular, we welcome the authors’ acknowledgement of the proven clinical benefits of selective decontamination of the digestive tract (SDD). The authors give four explanations why SDD is not yet widely used, but are unable to make a definitive recommendation regarding its use due to the perceived ‘‘lack of consistent benefit and unclear cost-effectiveness’’. Overall, 20 yrs of clinical research have yielded 56 randomised controlled trials (RCTs) of SDD and 12 meta-analyses [2]. SDD significantly reduced the odds ratio (95% confidence interval) for pneumonia [3], bloodstream infection [4] and mortality [3] to 0.35 (0.29–0.41), 0.63 (0.46–0.87) and 0.78 (0.68–0.89), respectively.