N Engl J Med

Does selective digestive decontamination reduce mortality in ventilated ICU patients?

November 10, 2025

Selective decontamination of the digestive tract (SDD) didn't reduce hospital mortality but was associated with fewer bloodstream infections and resistant organisms among treated patients. However, uncertainty about ecological safety and resistance limits routine adoption.

Study details: In a cluster-randomized trial (NCT02389036) across 26 ICUs in Australia and Canada, 9,289 mechanically ventilated patients were assigned to receive SDD or standard care for two 12-month periods. SDD included specific oral and gastric antimicrobials for the duration of ventilation and IV antibiotics for the first 4 days after enrollment. An additional 10,711 ICU patients were observed for ecological effects. Primary outcome was in-hospital death at 90 days; secondary outcomes included ICU mortality, ventilator-free days, and microbiologic measures.

Results: At 90 days, mortality was 27.9% with SDD and 29.5% with standard care (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.84–1.05; P=0.27). Bloodstream infections occurred less often with SDD (4.9% vs. 6.8%), and antibiotic-resistant organisms were cultured in 16.8% vs. 26.8%. Ecologic analysis didn't confirm noninferiority for resistance development. Serious adverse events were rare in both groups.

Source:

SuDDICU Investigators for the Australia and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group; Cuthbertson BH, et al. (2025, October 29). N Engl J Med. Selective Decontamination of the Digestive Tract during Ventilation in the ICU. https://pubmed.ncbi.nlm.nih.gov/41159880/