Selective Gastrointestinal Decontamination History of recognition and measurement of colonization resistance of the digestive tract as an introduction to selective gastrointestinal decontamination

Abstract

Selective decontamination of the digestive tract was developed following the observation that the digestive tract normally has considerable resistance to colonization by newly ingested bacteria. The research that eventually led to selective decontamination was performed because in the late 1960s and early 1970s, the need for prophylaxis against Gram-negative infections in immuno-compromized patients became evident. At that time, the relatively small number of antibiotics available for therapy of serious infections often lead to treatment failure. To introduce the subject of selective decontamination, this paper, therefore, starts with a short historical overview of the kind of infectious agents as well as the antibiotics available in the 1960s; particularly regarding the type and treatment of infections in severely compromised patients. The fact that the possibilities in infectious diseases were limited was the reason for our experimental search for ways of successful prophylactic treatment with minimal risk of development of resistance.

Gut Microbiota in Bipolar Depression and Its Relationship to Brain Function: An Advanced Exploration

“…B/E, the gut Bifidobacteria to Enterobacteriaceae ratio, used to describe the microbial colonization resistance against pathogenic bacteria of the bowel (35–37). Its validity is widely accepted by researchers (36, 38, 39).…”

“…They describe CR as the endogenous anaerobic fraction of the intestinal microflora (37). Then, it was discussed again in 1992 by van der Waaij D (35). Based on this, researchers in State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Zhongwen Wu et al put forward a new index called B/E ratio to quantify microbial colonization resistance of the bowel (40).…”

Selective digestive decontamination, a seemingly effective regimen with individual benefit or a flawed concept with population harm?

“…The SDD concept arose from studies using irradiated chimeric mice transplanted with leukemic cells which were at high risk of lethal blood stream infection arising from the digestive tract [ 5 – 7 ]. Earlier experiments demonstrated that increased susceptibility to oral challenge with Salmonella enteritidis was associated with loss of normally resident intestinal flora following prior antibiotic exposure.…”

“…These experimental mice were at high risk without protective isolation in germ-free conditions. A cross-infection incident with resistant Gram-negative bacteremia, arising from monkeys housed in the same research facility, dramatically illustrated this susceptibility with extensive loss of experimental mice [ 7 ].…”

Impact of digestive and oropharyngeal decontamination on the intestinal microbiota in ICU patients

“…Selective (microbial) decontamination of the digestive tract (SDD), developed using immuno-compromised animal models [ 1 , 2 ], was first clinically tested in severely immuno-compromised hemato-oncological patients and later applied to patients admitted to intensive care units (ICU) [ 3 ]. The concept of SDD is to selectively suppress potential pathogens, mostly Gram-negative bacteria, without disturbing the anaerobic intestinal microbiota.…”