Selective decontamination by antimicrobials during long term treatment: perspectives for saving host indigenous...

Short bowel syndrome (SBS) occurs in patients fed total parenteral nutrition (TPN) after massive intestinal resection. TPN weaning is often associated with occlusion or sepsis. In the present study the intestinal biotope was investigated in young patients (n = 14) with massive intestinal resection and recurrent symptoms of sepsis or occlusion during enteral food introduction. They were treated by aminosides for a long term period. Ileal effluents were collected for enumerating bacteria. In some case, blood and rectal specimen were also collected. A few patients developed bacterial overgrowth (1), occlusion (1), sepsis (4), osteoarthritis (1) or pneumonia (1) during the survey. A drastic drop of bifidobacteria that was not prevented by human milk feeding was observed prior occlusion or respiratory infection. Detection of clostridial vegetative forms preceded sepsis and decrease in clostridia parallelled recovery. In conclusion, onset of symptoms was related with extreme imbalance of the ileal flora. Supplementation with bifidobacterial compounds that were well tolerated in two patients could be of interest in children with recurrent symptoms.