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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
  1. MDR multi-drug resistant, CDI Clostridioides difficile infection, FMT fecal microbiota transplantation, ICU intensive care unit, VAP ventilator-associated pneumonia