Current state of affairs: SDD application in Dutch ICUs

Objective: To study the current application of selective decontamination of the digestive tract (SDD) in Dutch ICUs, the association between application and organizational characteristics, the various reasons for restraint in the use of SDD and differ- ent regimens that are currently practiced. Interventions: A point prevalence survey was carried out from February to July 2007. Measurements and main results: The response rate was 100%. SDD is currently used as an infection prevention strategy in 30% (n= 29) of Dutch ICUs, whereas 70% do not apply SDD (n= 69). The use of SDD is associated with a higher number of intensivists (p=0.004), a higher level ICU (p=0.042), more treatment days (p=0.013) and more mechanical ventilation days (p=0.003). Although the evidence based guideline of the Dutch Society of Intensive Care Medicine advises the implementation of SDD, 70% of ICUs do not follow this guideline. The main reason for not applying SDD is that the evidence to support it is deemed insufficient. Nearly all ICUs that have implemented SDD use the full SDD regimen of oral and gastro-intestinal application of SDD and a short course of additional systemic antibiotics. In some ICUs the application of SDD does not follow the optimal strategy. Conclusions: Seventy percent of Dutch ICUs do not follow the evidence based guideline produced by the Dutch Society of Intensive Care, as they do not use SDD. The use of SDD was associated with the number of intensivists, a higher level and a greater number of treatment days.