Summary
An outline is given of the various host-related and flora-related parts of the colonization resistance of the digestive tract. The host-related part of the colonization resistance has been found to be somewhat decreased by sublethal irradiation and leukemia (or chemotherapy), while treatment with antibiotics active against gram-positive flora may severely decrease the colonization resistance (depending on the antibiotic concentration established within the digestive tract during antibiotic therapy). The flora-related part of the colonization resistance, which controls colonization by potentially pathogenic microorganisms, differs greatly from one individual to the next. This observation appears to be important for the host-related part of the colonization resistance. Finally, it is concluded that in the clinical situation preference should be given to antibiotics which do not affect the part of the flora constituting colonization resistance for two reasons: 1) to limit the spread of (multi-) resistant potentially pathogenic microorganisms and 2) for infection prophylaxis in immunocompromised patients. In the latter situation, the potentially pathogenic microorganisms in the flora are selectively eliminated from the digestive tract, provided the antimicrobial drugs used for selective decontamination are active against the endogenous potentially pathogenic microorganisms and given in sufficient (oral) doses.
Zusammenfassung
Die verschiedenen Faktoren von seiten des Wirts und der Darmflora, die an der Kolonisationsresistenz des Verdauungstrakts beteiligt sind, werden dargestellt. Es hat sich gezeigt, daß der Beitrag des Wirtsorganismus zur Kolonisationsresistenz durch Bestrahlung mit subletalen Dosen und Leukämie (oder Chemotherapie) bis zu einem gewissen Grad vermindert wird. Die Behandlung mit Antibiotika, die gegen grampositive Keime der Darmflora wirken (abhängig von der im Verdauungstrakt unter der Therapie erreichten Konzentration) kann die Kolonisationsresistenz hingegen erheblich beeinträchtigen. Der Anteil der Darmflora, der die Kolonisationsresistenz darstellt und eine Kontrollfunktion bei der Besiedelung mit potentiell pathogenen Mikroorganismen ausübt, unterliegt starken interindividuellen Schwankungen. Diese Beobachtung scheint für den Beitrag des Wirtsorganismus zur Kolonisationsresistenz von Bedeutung zu sein. Wir kommen zu der Schlußfolgerung, daß aus zwei Gründen in der Klinik Antibiotika bevorzugt werden sollten, die keinen Einfluß auf den Anteil der Darmflora ausüben, der die Kolonisationsresistenz darstellt. 1. Um die Ausbreitung (multi-) resistenter, potentiell pathogener Mikroorganismen einzuschränken und 2. zur Infektionsprophylaxe bei Patienten mit beeinträchtigter Immunabwehr. Bei letzteren wird der Anteil der potentiell pathogenen Mikroorganismen der Darmflora selektiv aus dem Verdauungstrakt eliminiert, wenn eine selektive, orale Dekontamination mit gegen endogene, potentiell pathogene Mikroorganismen wirksamen Substanzen in ausreichender Dosierung durchgeführt wird.
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van der Waaij, D. Colonization pattern of the digestive tract by potentially pathogenic microorganisms: Colonization-controlling mechanisms and consequences for antibiotic treatment. Infection 11 (Suppl 2), S90–S92 (1983). https://doi.org/10.1007/BF01645295
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DOI: https://doi.org/10.1007/BF01645295