Selective Decontamination of the Digestive Tract in Adult Mechanically Ventilated Patients — An Updated Systematic Review with Bayesian Meta-Analysis
Naomi E. Hammond, Anthony Devaux, Ruan Vlok, et al
NEJM Evidence Published April 15, 2026
DOI: 10.1056/EVIDoa2500264
Abstract
BACKGROUND
There is uncertainty whether the use of selective decontamination of the digestive tract (SDD) as a preventive antimicrobial strategy reduces mortality in adult patients receiving mechanical ventilation in the intensive care unit (ICU). Following the publication of new data from a contemporary randomized clinical trial, an updated systematic review and meta-analysis was conducted to determine whether the use of SDD reduced hospital mortality compared to standard care.
METHODS
An updated systematic review of a previously published meta-analysis was conducted including a search from September 12, 2022, to August 18, 2025, for randomized clinical trials (RCTs) of adults receiving mechanical ventilation in an ICU that compared SDD to standard care. Data were pooled using a Bayesian framework. The primary outcome was hospital mortality or closest approximation.
RESULTS
One additional trial was identified, giving a total of 32 RCTs (27,687 participants), with 30 of the 32 RCTs (27,332 participants) contributing data to the primary outcome. The pooled estimated relative risk of hospital mortality for SDD compared to usual care or placebo was 0.91; 95% credible interval, 0.82 to 0.99, I2=33.3%; with a 99.2% posterior probability that SDD was associated with lower hospital mortality compared to standard care.
CONCLUSIONS
There is a high probability that in mechanically ventilated adults in the ICU, SDD, compared to standard care, is associated with a reduction in the risk of in-hospital death.
