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The gut plays a prominent role in the development of antibiotic resistance, allowing the hidden selection and multiplication of resistant microorganisms in the community, long-term care facilities, and hospitals. In a commentary published in Antimicrobial Resistance and Infection Control, Jean Carlet, of Fondation Hopital St Joseph in Paris, notes, "The emergence of resistant microorganisms in the gut may be related to the ingestion of highly pathogenic microorganisms or to antibiotic-induced alterations in the gut microbiome. The resistant organisms then contaminate the environment via the feces. Cross-transmission of the resistant strains can occur relatively easily if strong hygiene measures are not taken. However, these measures are not easy to implement."
Carlet adds that "Methods for preventing or controlling the appearance of antibiotic resistance in the gut include SDD, local antibiotic therapy, probiotics, and elimination of residual antibiotics from the gut (using enzymes or adsorbents). Studies are warranted to determine whether combining several of these methods in a search, destroy and restore strategy is effective and safe. The available data on the gut as a reservoir for antibiotic resistance are uncomplete, and much more will have to be learned before recommendations are made."
Reference: Carlet J. The gut is the epicentre of antibiotic resistance. Antimicrobial Resistance and Infection Control 2012, 1:39 doi:10.1186/2047-2994-1-39