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Selective decontamination of the digestive tract in critically ill children: fighting fire with fire or burning down the house?
  1. Debby Bogaert1,2,
  2. Willem van Schaik3
  1. 1Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
  2. 2Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
  3. 3Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Professor Willem van Schaik, Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2SQ, UK; w.vanschaik{at}bham.ac.uk

https://doi.org/10.1136/gutjnl-2024-331955

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    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 …

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    Footnotes

    • Contributors DB and WvS: conception, writing, review and final approval of the manuscript.

    • Funding Work in the group of WvS is supported by the MRC (MR/W031191/1) through the Joint Programming Initiative on Antimicrobial Resistance.

    • Competing interests DB has received research funding from GSK and OM Pharma and honoraria from Sanofi. WvS has received honoraria from Vedanta Biosciences.

    • Provenance and peer review Commissioned; internally peer reviewed.

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