Le microbiote intestinal est l'avenir de la multirésistance bactérienne

The human intestinal microbiota is our main bacterial reservoir with 1013-1014 cells. It is divided into a permanent (or resident) microbiota, which provides several benefits to its host, and a variable microbiota, made of exogenous bacteria that cannot sustainably settle because of the 'barrier effect' exerted by anaerobic bacteria. The intestinal microbiota is besides a major reservoir for antibiotic-resistant bacteria, which can be enriched by acquired multidrug-resistant bacteria such as enterobacteria that produce extended-spectrum beta-lactamases (ESBL) or carbapenemases. Antibiotics play a key role in this phenomenon in decreasing the species diversity within the intestinal microbiota while promoting the growth of resistant bacteria. In this review, we will see how the intestinal microbiota stands at the very heart of bacterial multidrug-resistance. We will tackle the different phases of the colonization by resistant bacteria and their underlying determinants, particularly the role played by antibiotics and the influence of the intestinal densities of multidrug-resistant bacteria on infections and patient-to-patient transmission. Eventually, we will review the current perspectives and those to come to combat the intestinal colonization by multidrug-resistant bacteria.