The study by Wittekamp and colleagues in this issue of JAMA evaluating strategies for decontamination of mechanically ventilated patients in the intensive care unit (ICU) fills an important gap in the evidence regarding these practices. Since the first use of selective decontamination of the digestive tract (SDD) in critically ill patients in the 1980s, the effectiveness of this approach to prevent ICU-acquired infections and reduce ICU-related mortality has been a continuous source of debate. In addition, the use of SDD or selective oropharyngeal decontamination (SOD) entails the continuous use of antibiotics among patients who do not have bacterial infections, thereby raising concerns about the possible development of antibiotic resistance.

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