The gut microbiome's role in the development, maintenance, and outcomes of sepsis

Max W. Adelman, Michael H. Woodworth, Charles Langelier, Lindsay M. Busch, Jordan A. Kempker, Colleen S. Kraft, Colleen S. Kraft, Greg S. Martin, Greg S. Martin

Research output: Contribution to journalReview articlepeer-review

201 Scopus citations

Abstract

The gut microbiome regulates a number of homeostatic mechanisms in the healthy host including immune function and gut barrier protection. Loss of normal gut microbial structure and function has been associated with diseases as diverse as Clostridioides difficile infection, asthma, and epilepsy. Recent evidence has also demonstrated a link between the gut microbiome and sepsis. In this review, we focus on three key areas of the interaction between the gut microbiome and sepsis. First, prior to sepsis onset, gut microbiome alteration increases sepsis susceptibility through several mechanisms, including (a) allowing for expansion of pathogenic intestinal bacteria, (b) priming the immune system for a robust pro-inflammatory response, and (c) decreasing production of beneficial microbial products such as short-chain fatty acids. Second, once sepsis is established, gut microbiome disruption worsens and increases susceptibility to end-organ dysfunction. Third, there is limited evidence that microbiome-based therapeutics, including probiotics and selective digestive decontamination, may decrease sepsis risk and improve sepsis outcomes in select patient populations, but concerns about safety have limited uptake. Case reports of a different microbiome-based therapy, fecal microbiota transplantation, have shown correlation with gut microbial structure restoration and decreased inflammatory response, but these results require further validation. While much of the evidence linking the gut microbiome and sepsis has been established in pre-clinical studies, clinical evidence is lacking in many areas. To address this, we outline a potential research agenda for further investigating the interaction between the gut microbiome and sepsis.

Original languageEnglish (US)
Article number278
JournalCritical Care
Volume24
Issue number1
DOIs
StatePublished - Jun 1 2020

Keywords

  • Sepsis, Gut microbiome, Review, Probiotics, Fecal microbiota transplant

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint

Dive into the research topics of 'The gut microbiome's role in the development, maintenance, and outcomes of sepsis'. Together they form a unique fingerprint.

Cite this