Antibiotic resistance: "search, destroy, and restore"

[Gert van der Hoek]

Publication date 27 November 2012

The gut is the epicentre of antibiotic resistance

Abstract
Antibiotic resistance develops in the gut, under the pressure of antibiotics. This paper
discusses the mechanisms, prevention, and treatment of this phenomenon and introduces the
search, destroy, and restore concept.

The gut contains very large numbers of bacteria. Changes in the composition of the gut flora,
due in particular to antibiotics, can happen silently, leading to the selection of highly resistant
bacteria and Candida species. These resistant organisms may remain for months in the gut of
the carrier without causing any symptoms or translocate through the gut epithelium, induce
healthcare-associated infections, undergo cross-transmission to other individuals, and cause
limited outbreaks. Techniques are available to prevent, detect, and treat the carriage of
resistant organisms in the gut. However, evidence on these techniques is scant, the only
exception being selective digestive decontamination (SDD), which has been extensively
studied in neutropenic and ICU patients. After the destruction of resistant colonizing bacteria,
which has been successfully obtained in several studies, the gut could be re-colonized with
normal faecal flora or probiotics. Studies are warranted to evaluate this concept.

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