Descontaminação Digestiva Seletiva em Doentes Hemato-Oncológicos Colonizados por Enterobacterales Resistentes aos Carbapenemos
DOI:
https://doi.org/10.20344/amp.23139Palavras-chave:
Carbapenemos, Descontaminação, Enterobacteriaceae, Infecções por Enterobacteriaceae, Neoplasias Hematológicas, Resistência Bacteriana a Medicamentos, Trato GastrointestinalResumo
As infeções causadas por bactérias Gram-negativo multirresistentes, entre os quais se incluem Enterobacterales resistentes aos carbapenemos, são uma preocupação global e o seu aparecimento crescente tem sido alarmante. Representam, assim, um grande desafio em termos de saúde pública devido à limitação de opções terapêuticas e elevadas taxas de mortalidade. Os doentes hemato-oncológicos representam uma subpopulação de elevado risco para este tipo de infeções, mais especificamente em doentes previamente colonizados por Enterobacterales resistentes aos carbapenemos, uma vez que apresentam frequentemente imunossupressão grave, não só pela doença em si como também devido aos tratamentos a que são submetidos, como quimioterapia intensiva ou alotransplante de células estaminais hematopoiéticas. A descontaminação digestiva seletiva surge como uma intervenção profilática destinada a reduzir ou eliminar a colonização por agentes patogénicos ao nível do aparelho gastrointestinal, preservando a flora endógena benéfica, embora a sua aplicabilidade se mantenha controversa principalmente pela elevada heterogeneidade entre estudos. Contudo, pretende-se com esta revisão avaliar o papel de descontaminação digestiva seletiva no contexto de doentes de elevado risco, como doentes hemato-oncológicos colonizados por Enterobacterales resistentes aos carbapenemos e que vão ser submetidos a tratamentos associados a imunossupressão grave, uma vez que desperta interesse como uma estratégia a curto prazo para prevenir infeções por esses mesmos agentes.
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