title: Dysbiosis in the intensive care unit: Microbiome science coming to the bedside.
abstract: Complex microbial communities within the human body, constituting the microbiome, have a broad impact on human health and disease. A growing body of research now examines the role of the microbiome in patients with critical illness, such as sepsis and acute respiratory failure. In this article, we provide an introduction to microbiome concepts and terminology and we systematically review the current evidence base of the critical-illness microbiome, including 51 studies in animal models and pediatric and adult critically ill patients. We further examine how this emerging scientific discipline may transform the way we manage infectious and inflammatory diseases in intensive care units. The evolving molecular, culture-independent techniques offer the ability to study microbial communities in unprecedented depth and detail, and in the short-term, may enable us to diagnose and treat infections in critical care more precisely and effectively. Longer term, these tools may also give us insights in the underlying pathophysiology of critical illness and reveal previously unsuspected targets for innovative, microbiome-targeted therapeutics. We finally propose a roadmap for future studies in the field for transforming critical care from its current isolated focus on the host to a more personalized paradigm addressing both human and microbial contributions to critical illness.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Center for Medicine and the Microbiome, University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA. Electronic address: kitsiosg@upmc.edu.
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Kitsios
authors.affiliation: Center for Medicine and the Microbiome, University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Division of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA. Electronic address: Michael.Morowitz@chp.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Morowitz
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: rodickso@med.umich.edu.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Dickson
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: ghuff@med.umich.edu.
authors.forename: Gary B
authors.initials: GB
authors.lastname: Huffnagle
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Center for Medicine and the Microbiome, University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA. Electronic address: mcverrybj@upmc.edu.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: McVerry
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Center for Medicine and the Microbiome, University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: morrisa@upmc.edu.
authors.forename: Alison
authors.initials: A
authors.lastname: Morris
mesh_terms: D000818:Animals; D003422:Critical Care; D016638:Critical Illness; D064806:Dysbiosis / Q000382:microbiology*; D019317:Evidence-Based Medicine; D006801:Humans; D007362:Intensive Care Units; D064307:Microbiota; D023421:Models, Animal
keywords: Acute respiratory distress syndrome; Acute respiratory failure; Dysbiosis; Microbiome; Microbiota; Sepsis