Selective Digestive Decontamination in Hemato-Oncological Patients Colonized with Carbapenem-Resistant...

Infections caused by multidrug-resistant Gram-negative bacteria, including carbapenem-resistant Enterobacterales, are a global threat and their gradual increase is alarming. They represent a major challenge to public health because of limited therapeutic options and high case-fatality rates. Hemato-oncological patients represent a high-risk subpopulation for these types of infections, more specifically in previous carbapenem-resistant Enterobacterales colonized patients, because of severe immunosuppression not only due to the disease itself but also due to treatment like intensive chemotherapy or allogeneic hematopoietic stem cell transplant. Selective digestive decontamination is a prophylactic intervention with the purpose of reducing or eliminating gut colonization by pathogenic agents, preserving beneficial endogenous flora but its application remains controversial due to great heterogeneity amongst studies. However, in this review we intend to examine the role of selective digestive decontamination in context of high-risk patients such as hemato-oncological carbapenem-resistant Enterobacterales carriers who will receive highly immunosuppressive treatments, as it appears to be an appealing short-term strategy for the prevention of difficult-to-treat infections.