How to improve infection prevention by selective decontamination of the digestive tract (SDD).

From the point of view of prevention, it is useful to divide infections in intensive care into exogenous infections and primary or secondary endogenous infections. Exogenous infections hardly play a role nowadays. With selective decontamination of the digestive tract (SDD) secondary endogenous infections can be effectively prevented, but for primary endogenous infections SDD comes too late. Primary endogenous infection is the major infectious problem in intensive care. A large number of these infections are postoperative infections and are responsible for a high morbidity and mortality in the intensive care unit. Many of these postoperative infections might be prevented if SDD were started before instead of after the operation when the patient is admitted to the ICU. A tentative list of indications for pre-operative SDD is presented with a flow diagram to determine the optimal infection prevention regimen.