Causes, consequences, and perspectives in the variations of intestinal density of colonization of multidrug-resistant enterobacteria

Abstract

The intestinal microbiota is a complex environment that hosts 10 13 to 10 14 bacteria. Among these bacteria stand multidrug-resistant enterobacteria (MDRE), which intestinal densities can substantially vary, especially according to antibiotic exposure. The intestinal density of MDRE and their relative abundance (i.e., the proportion between the density of MDRE and the density of total enterobacteria) could play a major role in the infection process or patient-to-patient transmission. This review discusses the recent advances in understanding (i) what causes variations in the density or relative abundance of intestinal colonization, (ii) what are the clinical consequences of these variations, and (iii) what are the perspectives for maintaining these markers at low levels.

Challenges of controlling a large outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae in a French university hospital

“…Antibiotic selection pressure is a major contributor to the alteration of the intestinal microbiota and probably prolongs the duration of the carriage. 14,15 The contaminated sink drains were not considered a permanent reservoir, but merely a transient reflection of bacteria in the environment around case patients. Sink drains were nevertheless systematically disinfected at weekly intervals during the outbreak period.…”

Prediction of the intestinal resistome by a novel 3D-based method

“…But if ARDs were to be mostly found located on the chromosome of their bacterial hosts, such stratification would be possible and would also open perspectives such as whether the microbiota of some subjects could resist the damage resulting from antibiotics exposure thanks to an inner important resistome when compared to subjects who would carry less ARDs. Indeed, whatever the route of administration or the purpose antibiotics may cause alterations in the composition of the intestinal microbiota and promotes the overgrowth of lowabundant, potentially pathogenic resistant bacteria over the susceptible ones 16,17 . Perturbations of the intestinal microbiota can be long-lasting, and could have consequences on health 18,19 .…”

“…Perturbations of the intestinal microbiota can be long-lasting, and could have consequences on health 18,19 . The scarce available data suggest that this effect is variable 16 , perhaps because of individual pharmacokinetics but also because of variations in the composition of the intestinal microbiota. Interestingly, some bacteria harbouring intrinsic ARDs might be involved in the protection of the intestinal microbiota towards antibiotics 20,21 , acting as "resilience" ARDs.…”

Extended-Spectrum ß-Lactamase-Producing Enterobacteriaceae : Antibiotic consumption, Detection and Resistance Epidemiology

“…Another possible approach to influence the intestinal flora is with probiotics or faecal transplantation. [212][213][214][215][216][217] …”