Selective Digestive Tract Decontamination: A Tough Pill to Swallow

Nosocomial infections are an important cause of death and excess length of stay in individuals hospitalized in the intensive care unit (ICU) (1). Ventilator-acquired pneumonia is common in this setting, occurring at an estimated incidence of 15 cases per 1000 ventilator-days (2). Notwithstanding the adoption of care guidelines that advocate best practices, such as the use of sterile water for enteral feeds, elevation of the head of the bed and optimal removal of ventilator circuit condensates, ventilator-acquired pneumonia is a frustratingly common occurrence (3). The reasons for this high burden of infectious disease in the intensive care unit extend beyond the obvious mechanical disruption of host defenses by invasive tubes and lines, and likely include the decline in immune function associated with critical illness.