Gut Microbiota Modulation: Implications for Infection Control and Antimicrobial Stewardship
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REVIEW
Gut Microbiota Modulation: Implications for Infection Control and Antimicrobial Stewardship Glorijoy Shi En Tan . Hui Lin Tay . Sock Hoon Tan . Tau Hong Lee . Tat Ming Ng . David Chien Lye
Received: June 12, 2020 Ó The Author(s) 2020
ABSTRACT The human microbiome comprises a complex ecosystem of microbial communities that exist within the human body, the largest and most diverse of which are found within the human intestine. It has been increasingly implicated in human health and diseases, demonstrably playing a critical role in influencing host immune response, protection against pathogen overgrowth, biosynthesis, and metabolism. As our understanding of the links between the gut microbiota with host immunity and infectious Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12689891. G. S. E. Tan T. H. Lee D. C. Lye (&) National Centre for Infectious Diseases, Singapore, Singapore e-mail: [email protected] G. S. E. Tan T. H. Lee D. C. Lye Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore H. L. Tay S. H. Tan T. M. Ng Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore T. H. Lee D. C. Lye Lee Kong Chian School of Medicine, Singapore, Singapore T. H. Lee D. C. Lye Yong Loo Lin School of Medicine, Singapore, Singapore
diseases deepens, there is a greater need to incorporate methods of modulating it as a means of therapy or infection prevention in daily clinical practice. Traditional antimicrobial stewardship principles have been evaluated to assess their impact on the gut microbiota diversity and the consequent repercussions, taking into consideration antibiotic pharmacokinetic and pharmacodynamic properties. Novel strategies of selective digestive decontamination and fecal microbiota transplantation to regulate the gut microbiota have also been tested in different conditions with variable results. This review seeks to provide an overview of the available literature on the modulation of the gut microbiota and its implications for infection control and antimicrobial stewardship. With increased understanding, gut microbiota profiling through metataxonomic analysis may provide further insight into modulating microbial communities in the context of infection prevention and control.
Keywords: Antimicrobial stewardship; Infection control; Infectious diseases; Gut Microbiota
Adv Ther
Key Summary Points Strategies to limit the negative effects of antibiotics on the gut microbiota include restricting the duration and spectrum of antibiotic use. Different routes of antibiotic administration have varying effects on the gut microbiota due to pharmacokinetic parameters, and these effects should be considered. There is insufficient evidence to recommend the routine use of selective oral decontamination and selective digestive decontamination to reduce the risks of nosocomial pneumonia in critically ill patients. The use of fecal microbiota transplants and probiotics have some role in restoring the gut micro
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