Colonisation resistance against multidrug-resistant bacteria: a narrative review

Colonisation resistance by gut microbiota is a fundamental phenomenon in infection prevention and control. Hospitalised patients may be exposed to multidrug-resistant bacteria when hand hygiene compliance among healthcare workers is not adequate. An additional layer of defence is provided by the healthy gut microbiota, which helps clear the exogenous bacteria and acts as a safety net when hand hygiene procedures are not followed. This narrative review focuses on the gut microbiota's role in colonisation resistance against multidrug-resistant bacteria and its implications for infection control. We discuss the underlying mechanisms of colonisation resistance (direct or indirect), the concept of gut microbiota resilience, the link between the antimicrobial spectrum and gut dysbiosis, and possible therapeutic strategies. Antimicrobial stewardship is crucial to maximising the effects of colonisation resistance. Avoiding unnecessary antimicrobial therapy, shortening the antimicrobial duration as much as possible, and favouring antibiotics with low anti-anaerobe activity may decrease multidrug-resistant bacteria acquisition and expansion. Even after antimicrobial therapy, the resilience of the gut microbiota often occurs spontaneously. Spontaneous resilience explains the existence of a window of opportunity for multidrug-resistant bacteria colonisation during or just after antimicrobial therapy. Strategies favouring gut microbiota resilience, such as high-fibre diets or precision pr...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news

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Introduction: The clinical relevance of bacteriophages in bronchiectasis remains unknown.Aim: To evaluate the bacteriophagome in bronchiectasis and assess correlation with antimicrobial resistance (AMR) and clinical status.Methods: We performed the largest metagenomic study in bronchiectasis to date (n=251) recruiting patients from four countries: Singapore (n=94), Malaysia (Kuala Lumpur) (n=38), Scotland (Dundee) (n=94) and Italy (Milan) (n=25). Patients were ‘matched’ by age, gender, and exacerbation status to allow for geographic comparisons. All specimens were subjected to whole-genome shotgun metagenomic s...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Respiratory infections and bronchiectasis Source Type: research
Objectives: Traditional antibiotic selection tests take days and fail to select effective antibiotics against Multidrug-resistant strains (MDR-strains) because they do not account for critical characteristics of "real-life" infections. AtbFinder – a novel culture-based test system addresses these realities by using a novel principle of antibiotic selection, named "populational response".Methods: 30 CF patients aged 18 to 65 years, with known chronic infection, receiving prophylactic antibiotic therapy with antibiotics selected based on AtbFinder results were monitored over 3 years. Sputum was obta...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Adult cystic fibrosis (CF) Source Type: research
We present a case of placental infection leading to preterm delivery, severe neonatal sepsis, maternal wound infection, postnatal readmission, and prolonged hospital stay. This virulent infection was caused by multidrug –resistant extended-spectrum beta-lactamase (ESBL)-producingEscherichia Coli (E.  Coli), which represent a major worldwide threat according to the Centre for Disease Control and Prevention (CDC). It was managed with appropriate antibiotic therapy, patient-centered approach, and multidisciplinary team involvement that led to favourable maternal and neonatal outcome.
Source: Clinical Case Reports - Category: General Medicine Authors: Tags: CASE REPORT Source Type: research
Purpose of review Gram-negative bloodstream infections (GNBSI) are common and carry considerable mortality. Treatment is complicated by increasing antimicrobial resistance, posing a challenge for timely appropriate antibiotics and limiting the choices of effective definitive therapy. The present review aims to summarize recent studies addressing the management of GNBSI. Recent findings New rapid diagnostic tests (RDT) for pathogen identification and antibiotic susceptibility are associated with improved antimicrobial stewardship and reduced length of stay. No mortality benefit or patient-related outcomes are rep...
Source: Current Opinion in Infectious Diseases - Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: BACTERIAL/FUNGAL: Edited by Monica A. Slavin Source Type: research
Purpose of review Emergence of multidrug-resistant organisms, impact on intestinal microbiome, side effects and hospital costs are some of the factors that have encouraged multiple studies over the past two decades to evaluate different duration of antibiotic therapy with the goal of shorter but effective regimens. Here, we reviewed the most recent relevant data on the duration of therapy focused on two of the most common Gram-negative organisms in clinical practice, Pseudomonas aeruginosa and Enterobacterales. Recent findings Recent studies including meta-analysis confirm that short antibiotic courses for both ...
Source: Current Opinion in Infectious Diseases - Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research
Conclusion: In high multidrug-resistant areas, empiric treatment with broader spectrum antimicrobials should be considered in neonates with sepsis shock or severe thrombocytopenia.
Source: The Pediatric Infectious Disease Journal - Category: Infectious Diseases Tags: Maternal-Neonatal Reports Source Type: research
CONCLUSION: The identification of risk factors for antimicrobial resistance and analysis of antimicrobial susceptibility might be important for concordant empirical antimicrobial therapy in patients with P. aeruginosa bacteremia.PMID:34751008 | DOI:10.3346/jkms.2021.36.e273
Source: Journal of Korean Medical Science - Category: Biomedical Science Authors: Source Type: research
Antimicrob Agents Chemother. 2021 Nov 1:AAC0162321. doi: 10.1128/AAC.01623-21. Online ahead of print.ABSTRACTEnterococcus faecium(E. fcm) is a significant multidrug-resistant pathogen. Bacteriophage cocktails are being proposed to complement antibiotic therapy. After a screen of 8 E. fcm strains against 4 phages, two phages(113, 9184) with the broadest host ranges were chosen for further experiments. Transmission electron microscopy, whole-genome sequencing, comparative genome analyses, and time-kill analyses were performed. Daptomycin(DAP) plus phage cocktail(113:myophage;9184:siphopage) showed bactericidal activity in mo...
Source: Antimicrobial Agents and Chemotherapy - Category: Microbiology Authors: Source Type: research
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