The microbial ecosystem of the human gut (‘the gut microbiome’) plays an important role in human health through a variety of mechanisms, including the degradation of complex carbohydrates, the production of vitamins and other beneficial compounds and by providing a barrier to invading pathogens.1 The gut can also be the source of pathobionts, including the Gram-negatives Escherichia coli , Klebsiella spp and other members of the family Enterobacteriaceae. These bacteria can be carried asymptomatically by the host but can also cause urinary tract or bloodstream infections, particularly in immunocompromised individuals. Specific hospital-adapted Enterobacteriaceae clones are circulating in healthcare systems and have acquired resistance to multiple classes of antibiotics.2 These multidrug-resistant strains are thus importantly selected for when patients are treated with antibiotics, while susceptible bacteria are simultaneously eradicated.3 The combined impacts of critical illness, antibiotic therapy and other factors associated with intensive care unit (ICU) stay frequently lead to a highly skewed gut microbiome that is characterised by overgrowth of a small number of antibiotic-resistant taxa.4 Patients hospitalised in ICUs are at a particularly high risk for antibiotic-resistant infections, primarily because of their underlying critical illness and the frequent use of antibiotics, which will select for bacteria with intrinsic or acquired resistances. To minimise the risk of these infections, a range of interventions have been proposed, including the use of chlorhexidine for body washes and oral care and the use of catheters …

中文翻译：

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危重儿童消化道选择性净化：以毒攻毒还是烧毁房屋？

人类肠道的微生物生态系统（“肠道微生物组”）通过多种机制在人类健康中发挥着重要作用，包括复杂碳水化合物的降解、维生素和其他有益化合物的产生以及提供入侵病原体的屏障.1 肠道也可能是病原体的来源，包括革兰氏阴性大肠杆菌、克雷伯氏菌和肠杆菌科的其他成员。这些细菌可以无症状地由宿主携带，但也可能引起尿路或血液感染，特别是在免疫功能低下的个体中。特定的医院适应肠杆菌科克隆在医疗保健系统中循环，并已获得对多种抗生素的耐药性。2因此，当患者接受抗生素治疗时，重要的是选择这些多重耐药菌株，同时消灭敏感细菌。3综合影响重症监护病房 (ICU) 住院期间的抗生素治疗和其他因素经常导致肠道微生物群高度扭曲，其特点是少数抗生素耐药类群过度生长。 4 入住 ICU 的患者处于特别危险的境地。抗生素耐药性感染的高风险，主要是因为他们患有潜在的危重疾病和频繁使用抗生素，这会选择具有内在或获得性耐药性的细菌。为了最大限度地降低这些感染的风险，人们提出了一系列干预措施，包括使用氯己定进行沐浴和口腔护理以及使用导管……