[The microbiome of the gut in critically ill patients].
BACKGROUND
The complexity and diversity of the human intestinal microbiome has only recently been characterized. The multiple metabolic and immunologic effects of the bacterial flora have demonstrated the symbiosis between the microbiome and its host. This symbiosis is disturbed in a multitude of diseases, especially in critically ill patients.


OBJECTIVE
A review of the changes in the intestinal microbiome of critically ill patients and the use of probiotics.


METHODS
Nonsystematic literature search in PubMed on the topics: (1) changes in the intestinal microbiome in critically ill patients, (2) interventions using probiotics in critically ill patients, and (3) use of fecal transplantation in Clostridium difficile colitis.


RESULTS
Trauma, sepsis, systemic inflammatory response syndrome, and other conditions lead to shifts in the composition of the intestinal microbiome, which are correlated with clinical outcome. The most obvious change is a profound loss of obligate anaerobe bacteria, leading also to metabolic changes. Probiotics have been used in several studies and show efficacy in the reduction of infectious complication but not in overall mortality. C. difficile colitis as the model disease for a disturbed microbiome can be treated effectively by transfer of donor feces, which also restores the diversity of the microbiome.


CONCLUSIONS
Taking into account the successful intervention of fecal transplantation on the intestinal microbiome, new products developed using the current knowledge of the intestinal microbiome could be more effective.
Stabsstelle Infektiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland. bernd.salzberger@ukr.de.
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Salzberger
Lehr- und Forschungseinheit Allgemeinmedizin, Universitätsklinikum Regensburg, Regensburg, Deutschland.
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C
Rauscher
D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000628:therapy; D000069467:Fecal Microbiota Transplantation; D054884:Host-Pathogen Interactions / Q000502:physiology; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D064307:Microbiota / Q000502:physiology; D019936:Probiotics / Q000627:therapeutic use; D013559:Symbiosis / Q000502:physiology
Antibiotics; Clostridium difficile; Colitis; Feces; Probiotics