Clinical use of selective decontamination: the concept
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D van der Waaij1, W L Manson, J P Arends
1Laboratory for Medical Microbiology, University of Groningen, The Netherlands.
Abstract:
Infections can be classified according to: (1) the type of offending microorganism (virus, bacteria, fungi, parasites), (2) according to the clearance by the defence system (T cell dependent/independent) and (3) in case bacteria are the causative agents in Gram-positive and Gram-negative infections. The latter classification in Gram-positive and Gram-negative infections has appeared to have a practical consequence. Gram-negative bacteria, often involved in major infections and yeasts, appear to play practically no role in the intestinal ecological system. Consequently, it is nowadays increasingly attempted to eliminate Gram-negative bacteria and yeasts selectively from the digestive tract with antimicrobial agents. Selective suppression of Gram-positive bacteria may severely affect the ecosystem of the digestive tract. This selective suppression of Gram-negatives must be continued as long as patients are immunocompromised (locally or systemically) and is called selective decontamination of the digestive tract.
Insights
Selective decontamination of the digestive tract aims to eliminate Gram-negative bacteria and yeasts, which rarely colonize the gut. This approach is crucial for immunocompromised patients to prevent severe infections.
Area of Science:
- Microbiology
- Immunology
- Infectious Diseases
Background:
- Infections are classified by causative agents (viruses, bacteria, fungi, parasites) and immune system clearance (T cell dependent/independent).
- Bacterial infections are further categorized into Gram-positive and Gram-negative, a distinction with significant clinical implications.
- Gram-negative bacteria and yeasts are frequently implicated in severe infections but play a minimal role in the intestinal ecosystem.
Purpose of the Study:
- To explore the rationale and application of selective decontamination of the digestive tract (SDD).
- To highlight the importance of targeting Gram-negative bacteria and yeasts in specific patient populations.
Main Methods:
- The study discusses the classification of infections and the ecological role of different microorganisms in the digestive tract.
- It reviews the strategy of using antimicrobial agents for selective pathogen elimination.
- Focuses on the clinical context of immunocompromised patients.
Main Results:
- Selective elimination of Gram-negative bacteria and yeasts from the digestive tract is a targeted therapeutic strategy.
- Conversely, broad suppression of Gram-positive bacteria can disrupt the gut's ecological balance.
- SDD is particularly relevant for immunocompromised individuals, requiring ongoing application.
Conclusions:
- Selective decontamination of the digestive tract is a strategy to reduce infection risk in immunocompromised patients by targeting specific pathogens.
- Preserving Gram-positive bacteria is essential for maintaining gut health.
- The approach necessitates continued application during periods of immune compromise.