[Disorders of intestinal flora in intensive care patients]

The intestinal flora under normal conditions prevents colonisation of the intestinal mucosa with pathogenic bacteria. Various diseases as well as antibiotics may disturb the host/bacteria balance. If patients are in addition immunocompromised, otherwise commensal bacteria may cause life threatening infections. Treatment of intensive care patients with antibiotics thus should account for preservation of resistance against colonization. Antibiotics active against anaerobes or poorly absorbed from the gastrointestinal tract, or excreted in the bile should be avoided. In patients with colitis induced by antibiotics the number of clostridium difficile with subsequent toxin production are greatly increased as a consequence of the killing of the normal anaerobic colon bacterial flora; in these patients vancomycin has to be applied. Mostly "dysbiosis" caused by antibiotics does not need any treatment. Therapeutic adjuncts like the administration of bacterial preparations e.g. lactobacilli are of no value.