Purpose: To discuss the relevant studies on selective decontamination of the digestive tract (SDD) in intensive care unit (ICU) patients regarding the occurrence of antibiotic- resistant bacteria. Findings: Since the introduction of SDD as a preventive infection measure in the ICU, there have been concerns about inducing antimicrobial resistance. Earlier studies proved that SDD reduces infections without a convincing clinical increase in resistant bacteria, but were not designed to assess this potential problem. In recent years, large prospective studies that were also designed to investigate the occurrence of resistant bacteria during SDD have shown a decrease in antibiotic-resistant Gram-negative bacteria. Increases of resistant Gram-positive bacteria and the increase of colistin resistance during SDD in a setting with an outbreak of extended spectrum beta lactamase producing Klebsiella pneumoniae have been reported. Conclusion: SDD reduces colonization, infection and mortality. No convincing overall increase of antimicrobial resistance can be attributed to the use of SDD. The use of SDD in ICUs with low levels of antibiotic resistance can be justified.