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Role of the microbiome, probiotics, and ‘dysbiosis therapy’ in critical illness

Wischmeyer, Paul E.; McDonald, Daniel; Knight, Rob

Current Opinion in Critical Care: August 2016 - Volume 22 - Issue 4 - p 347–353
doi: 10.1097/MCC.0000000000000321
METABOLIC SUPPORT: Edited by Paul E. Wischmeyer
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Purpose of review: Loss of ‘health-promoting’ microbes and overgrowth of pathogenic bacteria (dysbiosis) in ICU is believed to contribute to nosocomial infections, sepsis, and organ failure (multiple organ dysfunction syndrome). This review discusses new understanding of ICU dysbiosis, new data for probiotics and fecal transplantation in ICU, and new data characterizing the ICU microbiome.

Recent findings: ICU dysbiosis results from many factors, including ubiquitous antibiotic use and overuse. Despite advances in antibiotic therapy, infections and mortality from often multidrug-resistant organisms (i.e., Clostridium difficile) are increasing. This raises the question of whether restoration of a healthy microbiome via probiotics or other ‘dysbiosis therapies’ would be an optimal alternative, or parallel treatment option, to antibiotics. Recent clinical data demonstrate probiotics can reduce ICU infections and probiotics or fecal microbial transplant (FMT) can treat Clostridium difficile. This contributes to recommendations that probiotics should be considered to prevent infection in ICU. Unfortunately, significant clinical variability limits the strength of current recommendations and further large clinical trials of probiotics and FMT are needed. Before larger trials of ‘dysbiosis therapy’ can be thoughtfully undertaken, further characterization of ICU dysbiosis is needed. To addressing this, we conducted an initial analysis demonstrating a rapid and marked change from a ‘healthy’ microbiome to an often pathogen-dominant microbiota (dysbiosis) in a broad ICU population.

Summary: A growing body of evidence suggests critical illness and ubiquitous antibiotic use leads to ICU dysbiosis that is associated with increased ICU infection, sepsis, and multiple organ dysfunction syndrome. Probiotics and FMT show promise as ICU therapies for infection. We hope future-targeted therapies using microbiome signatures can be developed to correct ‘illness-promoting’ dysbiosis to restore a healthy microbiome post-ICU to improve patient outcomes.

aDepartment of Anesthesiology and Pediatrics (Nutrition Section), University of Colorado Denver, Denver, Colorado

bInstitute for Systems Biology, Seattle, Washington

cDepartment of Pediatrics, University of California, San Diego, San Diego, California, USA

Correspondence to Paul E. Wischmeyer, MD, EDIC, Department of Anesthesiology and Pediatrics (Nutrition Section), University of Colorado School of Medicine 12700 E. 19th Avenue, Box 8602, RC2 P15-7120, Aurora, CO 80045, USA. Tel: +1 720 848 6719; fax: +1 303 724 2936; e-mail: Paul.Wischmeyer@ucdenver.edu

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