Table 2 Advantages and disadvantages of potential interventions on the gut microbiota of intensive care patients
From: The role of the microbiota in the management of intensive care patients
| Fecal microbiota transplantation |
Consists in the administration of fecal material from healthy individuals for restoring a normal microbiota Now recommended for the treatment of recurrent C. difficile infection Reasonably safe treatment (rare side-effects) May constitute an option for MDR bacteria eradication (still being explored) New indications need to be extensively explored: e.g., severe CDI, abundant diarrhea, adjuvant treatment in sepsis/multiorgan failure Only heterologous FMT may be considered in ICU Hard to implement as a routine practice in ICU Lack of evidence specifically in critically ill patients Numerous unanswered questions: selection of patients and donors, administration modalities (route, antibiotics management), storage |
| Ribaxamase (SYN-004) |
Colon-delivered beta-lactamase hydrolyzing colonic beta-lactams residues Excellent tolerance Unchanged beta-lactams pharmacokinetics (observed for ceftriaxone) May prevent the alterations of microbial diversity after antibiotic administration |
| DaV-132 |
Adsorbent nonspecific activated charcoal with per os intake Neutralizes residual antibiotics in the colon and seems to have high capacity of antibiotic absorbance Ongoing studies targeting patients at high risk for C. difficile colitis (potential decrease of mortality in C. difficile-infected animals) |
| “Standard” probiotics |
Living microorganisms used to prevent dysbiosis Antimicrobial properties, positive impact on immune system, reduced gut cell death Seems to reduce infections (especially VAP and C. difficile infections) and antibiotic consumption in critically ill patients Discordant mortality results Potential side-effects: sepsis, bacteremia, endocarditis, abscesses, VAP |
| SER-109 |
“Targeted” probiotics Bacterial spores from Firmicutes spp. which may reduce C. difficile proliferation |