Infection control · Selective decontamination
Selective Decontamination of the Digestive Tract during Ventilation in the ICU
| Design | Cluster-randomised crossover trial with a parallel ecological assessment |
|---|---|
| Treatment | Selective decontamination of the digestive tract |
| Control | Standard care |
| Population | 20,000 patients across 26 ICUs: 9289 in the randomised trial and 10,711 in the ecological assessment |
| Follow-up | 90 days |
| Primary endpoint | In-hospital mortality |
| Result | At 90 days, 1175 of 4215 patients had died in one group, and selective decontamination did not reduce in-hospital death compared with standard care. |
| Secondary endpoints | Antibiotic-resistant organisms, Clostridioides difficile, ICU-acquired bacteraemia |
Among critically ill patients undergoing mechanical ventilation, SDD did not result in a lower incidence of in-hospital death than standard care.
The trial authors, in the published abstract
The definitive test of a strategy that had persuaded one country and no others. Its parallel ecological assessment addresses the standing objection to de Smet 2009 — that resistance harms accrue at unit level over time — and the mortality benefit did not survive.
Cuthbertson BH, Billot L, Campbell MK, et al. Selective Decontamination of the Digestive Tract during Ventilation in the ICU. N Engl J Med 2026 Apr 16;394(15):1491-1502.